The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Job Responsibilities:
- Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
- Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
- Services strategies policies and programs are comprised of network management and clinical coverage policies.
- Coordinates and implements assigned care plan activities and monitors care plan progress
- conducts multidisciplinary review to achieve optimal outcomes
- Identifies and escalates quality of care issues through established channels
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Provides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choices
- Help members actively and knowledgeably participate with their provider in healthcare decision-making
- Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Skills:
- License Registered Nurse
- 3+ years of clinical practice experience
- 1+ year Case Management experience
Education/Experience:
- Associate with RN License with current unrestricted state licensure
