Nurse Specialty Case Mgt - 19260

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.



Open House on August 25, 2006


9 a.m. - 3 p.m. 


Courtyard by Marriott Atlanta Buckhead
3332 Peachtree Road NE
Atlanta, GA 30326


 


Interviews will be scheduled



 


Must work until 8 p.m. one night per week.  Option 8 or 10 hour days.


 


Performs case management within the scope of licensure for members with complex and chronic care needs. Conducts assessments to identify individual needs. Identifies specific case management plans to address objectives and goals as identified during assessments. Implements care plan by facilitating authorization/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources available to meet identified needs. Monitors and evaluates effectiveness of case management plans. Modifies case management plans as necessary. Negotiates rates of reimbursement. Interfaces with Medical Directors and Physician Advisors on development of case management treatment plans. Assists in problem solving providers, claims or service issues. Prepares a specific case management plan to address objectives and goals as identified during assessment. Implements care plan as appropriate. Links members and providers to facilities, community agencies and provider/network resources. Participates in department Grand Rounds/Case Conference meetings. Independently identifies need for development of Utilization/Care Management policies and procedures or workflows, and crates them as needed. Actively chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Case Conferences. Prepares and presents in services for case management staff. Functions as preceptor for new case management staff. Actively participates in department audit activities. Performs other related duties as assigned.

Associates Degree (A.S.) in Nursing or equivalent. Current unrestricted RN license in applicable states. Five years clinical or home health/discharge planning experience, including previous case management experience. Thorough working understanding of health insurance/benefits industry.