Position Purpose
Perform collaborative duties to assess, plan and coordinate continuum of care for select members at high risk in order to promote quality, cost effective programs.
Knowledge/Experience
- Bachelor’s degree preferred.
- At least two years clinical nursing experience.
- At least two years experience managed care environment.
Position Responsibilities
- Advanced review of admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care.
- Develop, assess and adjust as necessary the care plan and promote desired outcome.
- Coordinate services between Primary Care Physician (PCP) specialist, and other medical and non-medical providers as necessary to meet the complete medical socio economic needs of clients.
- Provide patient and provider education.
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Data enters assessments and authorizations into the system.
Licenses/Certifications
- RN required.
- Current state nursing and driver’s license.
- CCM (Certified Case Manager) or other clinical certification preferred.