RN Case Manager - Complex Care
- Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care * 100% telephonic
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician \(PCP\), specialists, medical providers, and non\-medical staff as necessary to meet the complete medical socio economic needs of clients
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
- Direct care to participating network providers
- Perform duties independently, demonstrating advanced understanding of complex care management principles
- Participate in case management committees and work on special projects related to case management as needed
- RN
- 2+ year’s clinical nursing experience coming from an acute care setting
- Must have CM telephonic experience
- 2 years of Case Management Experience
- At least 1 year of experience coming from a Managed Care Setting strongly preferred
- Experience with medical decision support Interqural, Milliman software preferred
Interested in being considered?
If you are interested in applying to this position, please contact Tyler Lewitt 407-478-0332 ext. 171 and/or click the Green I’m Interested Button to email your resume.