Description
As business needs may require, this position may require additional state licenses either now or in the future. Inability or unwillingness to obtain these required licenses may result in either re-assignment (if available) or termination. Obtaining required licenses is a requirement for continued employment
Due to continued growth RN case managers needed, start dates available for July, August, September & October!
Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs. Primary duties may include, but are not limited to: Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures.
Qualifications
Requires BA/BS or higher in a health related field and licensure as a health professional, or certification as a care manager, or current unrestricted RN license in applicable state(s) and 5 years clinical experience or any combination of education and experience, which would provide an equivalent background. Requires knowledge of health insurance/benefits. Requires knowledge of care management assessment technique, provider community, and community resources. 3 years experience in home health/discharge planning preferred. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, and decision-making skills. The following are level distinctions that are not required for posting. This level reflects an experienced care manager with responsibility for more complex cases and a more complete continuum of care, with increased responsibility for identifying and managing linkage with external resources for discharge planning. **Work at home and flexible work hours may be available after fully trained**
Details:
Job Id:
40291
Annual Salary:
Position Type:
Education Level:
No Selection
Experience Level:
No selection
Posted:
6/9/2009 11:33:00 AM
Map
Careers & Community for Talented People with Disabilities