Case Manager
POSITION SUMMARY
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license.
The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria. The responsibilities of this position are to apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. Conducts comprehensive clinical assessments. Evaluates needs and develops flexible approaches based on member needs, benefit plans or external programs/services. Advocates for patients to the full extent of existing health care coverage. Promotes quality, cost effective outcomes and makes suggestions to improve program/operational efficiency. Identifies and escalates quality of care issues through established channels. Expectation is a very high level of customer service.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
REQUIRED SKILLS
Finance/Managing Aetnas Risk
General Business/Consulting for Solutions
Benefits Management/Maximizing Healthcare Quality
Organ Transplant Experience
Behavioral/Mental Health Experience
Computer Skills
FUNCTIONAL EXPERIENCES
Nursing/Case Management/Managed Care experience5-8 Years
Nursing/Disease Management/1-3 Years
Nursing/Discharge Planning/5-8 Years
Nursing/Transplant experience/1-3 Years
Nursing/Behavioral Health/5-8 Years
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.