Provides care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs.
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.
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 and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).

Associates degree in Nursing from an accredited nursing program required
Bachelor's degree in Nursing preferred
Two (2) 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
Ability to communicate effectively with a diverse group of individuals
Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Strong advocate for members at all levels of care
Must have valid driver's license, vehicle and verifiable insurance.

Behavioral Health Nurse Care Manager

About this role