RN Telephonic CM II with Managed Care Experience

Daily Responsibilities RN Case Managers:

• Position Purpose: 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.

• 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

Requirements:

• Must be an RN
• 1+ years of case management experience in a managed care setting is required
• 2+ years of acute care nursing experience.
• Knowledge of utilization management principles and healthcare managed care.
• Experience with medical decision support tools (i.e. InterQual, Milliman)

Hours for this Position:

M-F 8-5

Advantages of this Opportunity:

• Competitive salary
• Fun and positive work environment
• Room for growth
• Medical benefits 1st of the month after hire
• 401k Matching

Interested in being considered?

If you are interested in being considered for the position, please contact Ashley Greene at 407-478-0332 ext 169.