Large managed care company seeking an experienced RN Care Mgr to work a CONTRACT role who lives in Merrimack Valley (Lowell, Lawrence) and Springwell (Waltham, Watertown) area.
Location: Need to live here in Massachusetts about 30 miles max from 950 Winter Street Suite 3800 | Waltham MA 02451. Preferably in Merrimack Valley (Lowell, Lawrence) and Springwell (Waltham, Watertown) area.
Pay: $43.00 per hour
Contract: February to August 2020
Qualifications:
R.N. nurse licensure in MA
3 years of clinical practice experience
Bachelor's (or higher) degree in a health-related field preferred.
Case management certification preferred. Previous case management experience preferred.
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 the 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.
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.
Negotiate with providers when necessary to reduce patient costs.
Work closely with the family members of patients to involve them in patient care.
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.