Telephonic Nurse Case Manager Senior managing care for members with complex health needs. Responsible for developing and implementing care plans while collaborating with medical professionals.
Responsibilities
Responsible for care management within the scope of licensure for members with complex and chronic care needs
Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum
Performs duties telephonically or on-site for discharge planning
Ensures member access to services appropriate to their health needs
Conducts assessments to identify individual needs and develops a care management plan
Implements care plan by facilitating authorizations/referrals as appropriate
Coordinates internal and external resources to meet identified needs
Monitors and evaluates effectiveness of the care management plan
Interfaces with Medical Directors and assists in problem solving with providers and claims
Participates in department audit activities
Requirements
Requires BA/BS in a health related field
Minimum of 5 years of clinical experience
Current, unrestricted RN license in applicable state(s)
Multi-state licensure required if providing services in multiple states
Certification as a Case Manager is preferred
BS in a health or human services related field is preferred
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