Large managed care company looking for an RN Case/Care Manager for a contract opportunity lasting through the end of August 2021.

Position Description:

Assess, plan, implement, coordinate, monitor, and evaluate case management activities across the continuum of care, within the scope of the case manager's license, including: Coordination and service delivery, Physical and psychological factors, Benefit systems and cost benefit, Case management concepts and Community resources.

Understand and maintain confidentiality of legal and ethical issues at all times.

Check eligibility as per procedure/ client specifications; if there is an eligibility problem, the case manager notifies the caller and consults the case management supervisor.

Assess initial clinical information and develop a treatment plan and goals that meet the individual patient's/ client's present needs.

Communicate goals and objectives to all pertinent parties.

Evaluate and certify all cases for potential complications, and cases that would benefit from alternative care.

Assess clinical information at established intervals to evaluate the effectiveness of the case management plan for each patient.

Evaluate and communicate the case objectives and goals to the individual patient's case management team.

Consult physician advisers to determine the medical necessity and appropriateness of treatment plan goals and objectives.

Evaluate all referral sources and their qualifications to assure quality outcomes.

Determine the cost effectiveness and medical necessity of alternate treatment.

Negotiate with providers when necessary to reduce patient cost.

Work closely with the family members of patients to involve them in patient care.

Assess the psychological characteristics of wellness and illness. Note possible experimental/ investigational procedures and notify payer per contract specifications.

Attend weekly and monthly case management meetings to participate in problem-solving and goal-development techniques.

Maintain an open line of communication with all parties of the individual case management treatment team to include patient, family, payer, and service providers across the continuum of care.

Remain aware of and follow all departmental policies and procedures.

Answer calls as needed for individual assigned units.

Assume other duties as assigned and directed by the case management supervisor.

Report directly to the case management supervisor.

Report any quality issues identified to the case management supervisor.

Qualifications: Active R.N. nurse licensure in the state of operation; minimum of 3 years clinical practice experience in state of operation.

A Bachelors (or higher) degree in a health-related field preferred.

Case management certification preferred.

Previous case management experience preferred. Ability to apply the six (6) essential activities of case management within the five (5) core components