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.
In this role, you will be responsible for assessing, monitoring, implementing and evaluating care and services for patients to ensure their healthcare needs are addressed across the care continuum. Utilizes evidence-based resources to guide and improve appropriateness of case strategies.
In this role, you will be responsible for authorize and coordinate required services in accordance with the benefit plan and works collaboratively with the utilization management department for prior authorization requirements.
In this role, you will be responsible for reviewing and assessing the appropriateness of managed care members inpatient and outpatient medical care to ensure medical necessity and cost effectiveness under the supervision of the Medical Director through regular review of the inpatient admissions, outpatient services, discrepancies in U.M. criteria, utilization of services, and alternatives to inpatient care.