The nurse case manager is responsible for performing 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. The candidate performs duties telephonically or on-site such as at hospitals for discharge planning. S/he ensures member access to services appropriate to health needs. This position 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. S/he coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. The applicant interfaces with medical directors and physician advisors on the development of care management treatment plans. The role negotiates rates of reimbursement, as applicable. The incumbent assists in problem solving with providers, claims, or service issues.
What your background should be
The candidate must have 3 years of clinical experience in related field. Current, unrestricted rn license in new york is required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a case manager is preferred.
Required Schooling / Training
BA/BS in a health related field or equivalent required.
Who is the client company
This is one of the largest for profit managed health care company.
If you are interested in this position, send your resume to apply@kochdavis.com
