RN Field Case Manager

• In conjunction with the PCP member member’s family and other pertinent members of the Interdisciplinary Care Team (IDT) CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member’s need for alternative services.

• Assesses short-term and long-term needs and establishes case management objectives.

• Manages 75 to 100 active cases based on case intensity and acuity.

• Responsible for Utilization Management and uses prescribed criteria to provide timely appropriate and medically necessary service authorizations.

• Interacts continuously with member family physician(s) IDT members and other providers utilizing clinical knowledge and expertise to determine medical history and current status.