Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
Provide patient and provider education
Facilitate member access to community based services
Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Direct care to participating network providers
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications: Current state’s RN license.
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Nurse Resolutions is a specialized recruiting and staffing firm with a focus of placing nurse, social work and other healthcare professionals into temporary, contract and permanent positions nationwide. The companies we partner with include hospitals, managed care organizations, insurance providers, medical management groups, third-party administrators, home health organizations, long term care facilities, pharmacies, outpatient clinics, healthcare consulting companies, medical supply organizations and many other types of companies. We recognize that a company’s success is strongly correlated with the talent that it attracts. Our firm utilizes a unique platform, combining proactive and passive recruiting methods with proven success to create value for client and candidate every time. Our recruiting strategies save time and effort while consistently ensuring highly-skilled professionals to the companies we partner with.