Nurse Case Manager I coordinating care for members diagnosed with chronic illnesses. Performing care management and monitoring member health care across the care continuum.
Responsibilities
Work with our members diagnosed with chronic illnesses
Conduct assessments to identify individual needs and develop a specific care management plan
Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure
Coordinate internal and external resources to meet identified needs
Monitor and evaluate effectiveness of the care management plan and modify as necessary
Interface with Medical Directors and Physician Advisors on treatment plans
Negotiate rates of reimbursement, as applicable
Assist in problem solving with providers, claims or service issues
Requirements
Requires BA/BS in a health related field and minimum of 3 years of clinical experience
Current, unrestricted RN license in applicable state(s) required
Multi-state licensure is required if this individual is providing services in multiple states
Certification as a Case Manager is preferred
Experience working in home health is preferred
Benefits
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs (unless covered by a collective bargaining agreement)
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