HN02 – Case/Care Management Nurse – Field
HN02 – Case/Care Management Nurse – Field-ManagementSUMMARY Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs. This level typically deals with the least complex cases and works under general guidance, having had limited or no previous managed care experience. MAJOR DUTIES AND RESPONSIBILITIES Conducts assessments to Read more […]
HN02 – Case/Care Management Nurse – Field
HN02 – Case/Care Management Nurse – Field-ManagementSUMMARY Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. MAJOR DUTIES AND RESPONSIBILITIES Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately Read more […]