Case Manager, RN

JOB SUMMARY: The health plan case manager is responsible for managing cases involving complex, or catastrophic illness or injury to insure cost effective and efficient utilization of health services.  She/he acts as a patient advocate, seeking and coordinating creative solutions to patients? health care needs without compromising quality of outcomes.  Case Managers may be specifically geared to certain disease management; for example, high-risk maternity, asthma, HIV or behavioral health.


PRIMARY RESPONSIBILITIES:

Medical Management activities to include the following:
1. Coordination and service delivery:
? Obtains accurate history
? Assesses clinical information to develop treatment plans
? Establishes short and long terms goals that meet the member?s needs and the referral source?s requirement
? Establishes working relationships with referral sources
? Communicates case objectives to appropriate individuals/departments/referral sources
? Maintain member confidentiality
2. Assessment of physical and psychological factors:
? Identifies cases with potential for high risk complications
? Acts as an advocate for an individual?s health care needs
? Demonstrates understanding of methods for assessing an individual?s present level of physical/mental impairment
? Understands the physical and psychological characteristics of illnesses and wellness
3. Review of benefit systems and cost benefit analysis:
? Evaluates the quality of necessary medical services
? Demonstrates understanding of requirements for prior approval by health plan
? Identifies cases that would benefit from alternative care
? Acquires data and evaluates necessary medical services for cost containment
? Demonstrates understanding of home health resource and health care delivery systems
4. Knowledge of case management concepts:
? Documents and demonstrates effectiveness of case management services
? Applies problem solving techniques to the case management process
? Demonstrates understanding of liability issues for case management activities
? Develops case management plans to address the individual?s needs
5. Knowledge of community resources:
? Demonstrates understanding of interviewing techniques
? Knows how to establish a client support system
? Demonstrates understanding of assistive devices/adaptive equipment needed for individuals with disabilities
? Demonstrates knowledge of community resources, state and federal initiatives regarding member disability
6. Provision of services to include:
? Demonstrates skills assessment, planning, implementation, coordination, monitoring and evaluation
? Requests direction from Medical Director on complex issues
7. Other duties as requested or assigned

JOB REQUIREMENTS

Education and experience:
? 3-4 years experience in health care, case management or discharge planning
? Bachelor?s degree required

Certification and Licensure:
? RN required with current license
? Certified case manager preferred
? Must possess a valid driver?s license and access to a motor vehicle

Knowledge and Skills:
? Excellent verbal and written communication skills.
? Strong decision making skills
? Ability to provide services in an environment that involves multiple health care systems
? Ability to interact with all relevant components of the health care system
? Ability to provide services that deal with the individual?s broad spectrum of needs
? Self-started with ability to handle multiple projects at one time
? Appreciation of cultural diversity and sensitivity towards target population

Physical Requirements:
? Must be able to operate a computer.
? Must be able to operate a telephone.
? High energy level

 

Please apply online at: www.amerigroupcorp.com