Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
Performs duties telephonically.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Assists in problem solving with providers, claims or service issues.
Requirements
Requires BA/BS in a health related field and minimum of 3 years of relative clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in applicable state(s) required.
Multi-state licensure is required if this individual is providing services in multiple states.
Case Management experience is preferred.
Certification as a Case Manager is preferred.
Minimum 3 years experience in acute care setting preferred.
Managed Care experience is preferred.
Ability to talk and type at the same time.
Demonstrate critical thinking skills when interacting with members.
Strong computer skills (including Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
Ability to manage, review and respond to emails/instant messages in a timely fashion.
Strong organization and time management skills with the ability to work independently.
Branch Manager in Training at Advance America delivering results related to sales goals and customer expectations. Focusing on enhancing customer experience and adhering to company policies and practices.
Assistant Store Manager at Lids responsible for driving sales and customer service in retail. Supervising store activities and ensuring merchandise presentation aligns with company standards.
Assistant Store Manager driving sales and customer service at Lids locations. Aiming to meet company objectives through effective team supervision and operational management.
Assistant Store Manager at Lids providing customer service and driving sales performance. Responsible for supervising associates and adhering to company policies and procedures.
Manage building and maintenance projects as Facilities Manager at Crown Equipment Corporation. Overseeing budgets, projects, and compliance with safety policies and procedures.
Clinic Manager overseeing daily operations and patient care at Medcor's occupational health clinic. Collaborating with key stakeholders to ensure effective clinic workflows and logistics.
Clinic Manager overseeing operations in a worksite health & wellness clinic for Medcor. Responsible for patient care and collaborative health service functions in a team environment.
Manager overseeing operational aspects of laboratory services at Children’s Healthcare of Atlanta. Ensuring quality service, promoting lean work culture, and collaborating with leadership team.
Nutrition Manager overseeing dietary services and meal planning for ERC Pathlight locations. Leading a team of dietitians in a supportive healthcare environment treating eating disorders.
DAS Field Manager overseeing installation projects for Distributed Antenna Systems. Ensuring quality, safety, and project management in customer locations across Phoenix and surrounding areas.