RN Care/Case Manager

About the Job:

• Strictly telephonic

• Working as a case/care manager for all ages from Peds to Geriatric, coordinating services and identifying barriers to care (Medicare & Medicaid members).

• Keeping patients on track with care plans and educate them about their conditions and treatments.

• Could be contacting providers (doctors) to clarify information/plans and then relaying that info back to the patient.

• Flagging any potential issues and teach patients how to know when they should get themselves to a hospital.

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

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• Develop, assess and adjust, as necessary, the care plan and promote desired outcome

• 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

• 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

• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs

• 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

• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems