Key skills
Critical ThinkingProblem Solving
About this role
Role Overview
- responsible for care management within the scope of licensure for members with complex and chronic care needs
- assesses, develops, implements, coordinates, monitors, and evaluates care plans designed to optimize member healthcare across the care continuum
- performs duties telephonically
- ensures member access to services appropriate to their health needs
- conducts assessments to identify individual needs and a specific care management plan to address objectives and goals
- implements care plan by facilitating authorizations/referrals as appropriate within benefits structure
- coordinates internal and external resources to meet identified needs
- monitors and evaluates effectiveness of the care management plan and modifies as necessary
- interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
- negotiates rates of reimbursement, as applicable
- assists in problem solving with providers, claims, or service issues
- assists with development of utilization/care management policies and procedures
Requirements
- BA/BS in a health-related field
- minimum of 5 years of clinical experience
- current, unrestricted RN license in applicable state
- Multi-state licensure required
- Case Management experience (preferred)
- certification as a Case Manager (preferred)
- minimum 2 years’ experience in acute care setting (preferred)
- Managed Care experience (preferred)
- ability to talk and type at the same time (preferred)
- demonstrate critical thinking skills when interacting with members (preferred)
- experience with Microsoft Office (preferred)
Benefits
- health insurance
- retirement plans
- paid time off
- flexible work arrangements
- professional development
- bonuses
- stock options
- wellness programs
- 401k contribution