Care Manager II (RN Case Manager)

Location: Big Spring, TX
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
  • For New Hampshire and Massachusetts - home visits required

Qualifications:
Education/Experience:
  • Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
  • 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.
  • 2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
  • Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
  • Other state specific requirements may apply.

    Licenses/Certifications:
  • Current state’s RN license. 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 

www.linkedin.com/in/aprilaestes
 
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