Job Title: Health Plan Care Manager
Profession: RN
Specialty: Health Plan Care Manager
Duration: 13 weeks
Shift: Day Shift
Hours per Shift: 40 hours a week, M-F
Experience: Preferred nursing experience
License: Registered Nurse (RN) licensure in the state of practice required
Certifications: Certified Case Manager (CCM) preferred
Description:
Manages the development, implementation, and evaluation of care management service lines.
Enhances the quality of member management by promoting continuity of care and cost-effectiveness.
Integrates whole person in-patient and out-patient management, care integration, case management, utilization review, and care planning.
Partners with internal and external physician advisors, as well as claims and data management departments.
Provides safeguards, processes, and expected outcomes for the member population.
Performs and/or coordinates preventative care, wellness, and nutritional counseling.
Develops and maintains positive relationships with internal and external customers.
Collaborates with physicians, staff, and leadership on quality and performance improvement activities.
Focuses on optimal utilization of resources and efficient delivery of high-quality care.
Ensures patient flow, capacity management, and other clinical cost reduction initiatives.
Performs ongoing collaboration with staff to ensure that a member’s medical condition meets medical necessity criteria.
Communicates changes that could affect the discharge plan of care.
Manages communication related to discharge planning and utilization management.
Performs other job-related duties as assigned.
Commits to the safety and well-being of associates and members.
Requires that all associates receive all required vaccinations as a condition of employment, where applicable.