Desk Nursing Opportunity with Normal Working Hours
• The Case Manager coordinates the care and services of selected member populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes.
• Serve as a team member on a multidisciplinary Health Care Coordination team that monitors utilization patterns; identifies and facilitates appropriate health care service delivery for selected members, providers, procedures, and/or diagnoses; and improves the quality and cost efficiency of care and service.
• Perform a comprehensive assessment of the member’s health status, educational, and level of support needs. The assessment includes condition specific issues, clinical history, medications, and activities of daily living, mental health status, cognitive functioning, and life planning activities, cultural and linguistic needs, caregiver support and resources. • Develop a member centric care plan which includes long and short term goals, a self-management plan tailored to member’s needs, and identification of barriers to meeting goals or compliance to plan of care.
• Perform ongoing monitoring and management of member including: scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation to MD, MSW, HLB, etc; assessment of progress towards goals, modification of plan/goals as needed, nurse contact at least every 30 days, complete documentation of calls and faxes with phone and fax numbers
• Evaluate and facilitate care provided to members as they move through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care). Review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options.
• Identify high risk, high cost, or high utilization cases. Encourage pro-active intervention to limit expense and encourage positive outcomes.
• Maintain awareness of community resources and funding. Utilize resources and funding sources in the development of the case management plan
MUST be very proficient with Computers
MUST have Previous Case Management experience in hospital setting or insurance setting.
MUST have NC RN License for this position