The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services
Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status
Authorizes covered services and coordinates care regardless of payer
Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team
Works with member/family to maintain the most independent living situation possible
Assesses, plans and provides continuous care management across all venues of care
Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria
Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs
Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member
Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings
Documents care management/coordination according to company policy

Associates degree in Nursing from an accredited nursing program required
Bachelor's degree in Nursing preferred
Three (3) years of experience as a registered nurse required
Clinical experience in geriatrics and/or managed long-term care experience preferred
Experience using multiple languages may be required based on operational needs

Registered Nurse, Care Manager

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