The Case Manager is responsible for performing effective acute and ambulatory case management, utilization management and claims review activities to ensure appropriate, cost-effective care to Health Plan members, while always maintaining the highest quality of service.
The Case Manager is skillful in transition of care for health plan members throughout the health delivery system and acts as advocate as well as liaison between providers, and members. Strong acute utilization review and case management background in managed care is essential.
The Case Manager is responsible for performing effective acute and ambulatory case management, utilization management and claims review activities to ensure appropriate, cost-effective care to our health plan members, while always maintaining the highest quality of service.
Position works closely with Primary Care and Specialist physicians, Medical Director, ancillary providers and case management to coordinate member care. Position performs function of a clinical resource to non-licensed staff.
The Case Manager will assess, plan, intervene and evaluate patient outcomes for individuals with diabetes whose current status is outside the target range. Diabetes Disease Managers carry a caseload taken from a population of individuals whose diabetes acuity has been determined to be severe, using a stratification process that incorporates data from available encounter, lab, medication, and admission databases.
The successful candidate has proven leadership skills and knowledge of state regulatory requirements and URAC. The RN Case Manager will work Monday through Friday during normal business hours in a comfortable and modern professional office environment.
Coordinates and monitors the social and psychotherapeutic services rendered to patients and their families. Performs psychosocial assessments, prepares after-care plans and provides group therapy as assigned by the program manager.
In this role, you will plan and administers prescribed skilled physical therapy treatment and training for patients suffering from various injuries, illnesses and functional disabilities to attain highest level of physical function.
The CM will coordinate with the health care team and the patient/family to address payer issues that impact care, and to develop a transition plan of care that includes a safe discharge plan and plan for follow up with care providers post discharge.