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.
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, the selected candidate will coordinate and monitor services in the benefit package that are necessary and appropriate to support member outcomes in the most effective and cost-effective manner as well as provide oversight of natural supports.
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.
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.
The Case Manager is responsible for providing a full range of case management services that includes initial and ongoing assessment, development of person-centered plans, monitoring and documenting progress, counseling and communicating with guardians, families and funding sources.