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
Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs
Ensures appropriate, safe plan for members’ discharge from their plan
Identifies same day grievances, investigates and documents accordingly
Documents any grievance according to plan policy
Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM)
Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT and formulates appropriate plan of care
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
Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Bilingual speaking and writing skills are preferred.

Registered Nurse, Care Manager

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