Responsible for providing case management services to maximize opportunities available to people living in the community who are trying to recover from the catastrophic effects of a serious mental illness.
The RN case manager will identify potential barriers to care and develop an individualized care management plan using a holistic approach to assist members with achieving their identified health goals.
Participate in the coordination of services with other disciplines and community resources as needed, evaluate and revise care plans / assessments based on changes in patients and / or their environments.
The Case Manager is responsible for ensuring prior authorizations, re-authorizations and appeals are obtained timely as well as ensuring accurate documentation of payer information and patient status. In addition, the Case Manager is responsible for completing a pre-screen to determine eligibility for additional services such as Injection Services, Copay, PAP if applicable.