Responsible for effective benefit management, utilization of services and resources. Reviews to determine appropriateness and medical necessity, continued stay and the use of ancillary services using concurrent review process.
Assists the clinical staff in obtaining orders from the physician/practitioners office, only a registered pharmacist can obtain verbal medication orders directly from the physician/practitioners office.
Act a resource, provides leadership, administration and support to HMHP Continuum Navigators, HMHP ED Care Coordinators and Social Services to ensure achievement of HMHP strategic and operational plans.
Establishes a collaborative relationship with the client (plan participant), family, physician(s), and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care.
Collaborate to assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individuals health needs through communication and available resources to promote quality, cost-effective outcomes.
Collaborates across a broad continuum of care to assess, plan, implement, coordinate, monitor and evaluate services to meet individual health care needs and organizational goals related to quality outcomes, member experience, and cost-efficiency.
As a RN Case Manager, your ability to manage client care with specific knowledge and experience in bedside care, symptom management, crisis intervention and family intervention are feature assets for this high-profile nursing position.