Bilingual Spanish Enrollment Nurse (RN)

Will assess members in field at clinical and home settings for a large established managed care organization (MLTCP).  Smaller territories and lower case loads.

 Bilingual Spanish Enrollment Nurse (RN) - handles 2 or 3 members a day. 

·         Obtains an accurate member history and assesses clinical information to develop care plans including a member support system.

·        Establishes short and long term goals in collaboration with the member that meet the members needs and the referral sources requirements.

·        Establishes working relationships with referral sources and community resources.

·        Communicates care objectives to appropriate individuals/departments/referral sources.

·        Assessment of biopsychosocial factors.

·        Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

·        May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

·        Acts as an advocate for an individual’s health care needs.

·        Reviews benefit systems and cost benefit analysis.

·        Evaluates the quality of necessary medical services.

·        Utilizes criteria for authorizing appropriate clinical services.

·        Identifies members that would benefit from an alternative level of care.

·        Acquires data and evaluates necessary health services for cost containment.

·        Documents effectiveness of case management services.