The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

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