RN Telephonic CM II with Managed Care Experience

Daily Responsibilities RN Case Managers:

• 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

• Perform duties independently, demonstrating advanced understanding of complex care management principles.

• Participate in case management committees and work on special projects related to case management as needed