Registered Nurse (RN) with a current unrestricted nursing license required.
5-7 years of experience in case management or related field preferred.
Strong clinical assessment and evaluation skills.
Ability to coordinate and monitor healthcare services effectively.
Experience with utilization management and health education.
Responsibilities
Deliver delegated tasks assigned by a supervisor in Nurse Case Management.
Plan, implement, and evaluate healthcare services aligned with physician treatment plans.
Utilize clinical skills to assess and coordinate healthcare options for members.
Evaluate effectiveness of care services to ensure quality and cost-effective outcomes.
Conduct clinical assessments and provide health education to members.
Perform reviews for inpatient and outpatient services while managing a personal caseload.
Resolve non-routine issues escalated from junior team members.
Benefits
Access to mentorship from experienced team members.
Opportunities for professional development and training.
Flexible work environment with autonomy in case management tasks.
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.
