In this role, the Transition Case Manager will be responsible for managing the care of high risk patients, community clients or populations that are at risk for poor health outcomes and frequent hospital re-admissions.
As a Telephonic Complex Case Manager Nurse, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating.
This position is responsible for having a thorough understanding of patient treatment plans through participative discussions with the care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing inpatient and outpatient services requiring MCO approval.
The RN Case Manager is responsible for performing physical and psychosocial assessment on patients at the end stage of life; develop and implement a nursing plan of care and makes recommendations for care based on patients' needs.
In this role, you will provide quality cost-effective care to all members by evaluating the need for and pre-authorizing requests for inpatient, outpatient, specialty care, home care, DME, and transportation services, from network and out of network providers, in accordance with departmental criteria and guidelines.