RN Field Case Manager
- 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
- Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
- 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience
- Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
- Licenses/Certifications: Current state’s RN license
Interested in being considered?
If you are interested in applying to this position, please contact Edgar Pablo @ 407-478-0332 ext 114 and click the Green I’m Interested Button to email your resume.