Job Description

Job Responsibilities:

• Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
• Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Coordinates and implements assigned care plan activities and monitors care plan progress
• conducts multidisciplinary review to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choices
• Help members actively and knowledgeably participate with their provider in healthcare decision-making
• Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Skills:

• License Registered Nurse
• 3+ years of clinical practice experience
• 1+ year Case Management experience

Education/Experience:

• Associate with RN License with current unrestricted state licensure

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