Valid RN license and unrestricted nursing license required.
Experience in Nurse Case Management preferred.
Strong clinical assessment and evaluation skills needed.
Demonstrated ability to plan and coordinate healthcare services.
Familiarity with utilization management and quality care principles.
Responsibilities
Deliver delegated tasks from supervisors in Nurse Case Management.
Plan, implement, and evaluate healthcare services with physicians.
Utilize clinical skills for coordinating and monitoring healthcare options.
Evaluate effectiveness of care services to meet program objectives.
Provide clinical assessments and health education to members.
Conduct reviews for inpatient and outpatient services.
Manage and coordinate own caseload independently.
Benefits
Access to advice from experienced team members for complex cases.
Opportunity for professional development within the healthcare field.
Involvement in a program aimed at delivering quality and cost-effective care.
Full Job Description
Description:
Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family.
Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.
Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
Provides clinical assessments, health education, and utilization management to members.
Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
Manages own caseload and coordinates all assigned cases.
Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.
Tasks involve a degree of forward planning and anticipation of needs/issues.
Resolves non-routine issues escalated from more junior team members.
RN and current unrestricted nursing license required.
