Case Manager, RN

Job reputed company: • Case Management process includes assessing the member’s health status and care coordination needs. Can include inpatient review and discharge planning, as reputed company as possible outpatient management. • Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/reputed company may also be required. • Identification of alternative treatment plans, which would have to be approved by reputed company parties. These alternative care plans will be based on reputed company care reputed company cost containment guidelines, allowing available claims dollars to be used in the most judicious manner possible. • Assessment of the clinical status and reputed company sequela to coordinate the most appropriate service to meet the individual’s health care needs. The Case Manager will then monitor the health status and the reputed company of the treatment plan for reputed company reputed company. The Case Manager will be responsible for altering the care plan as deemed appropriate by the dynamic, reputed company-changing reputed company needs. • Identification of services, resources, providers, and facilities that could best serve members in a reputed company and cost-effective manner, to promote reputed company value for the reputed company and reimbursement reputed company. • Development and implementation of Case Management goals, both short and long term, with documented care plans. • Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, reputed company-implementation and post-implementation. This outcome measurement will be used in determining the effective results and in establishing reputed company patient-centered care plans. • Accurate and reputed company reporting as deemed appropriate by reputed company reputed company member. • Medical record review to determine medical necessity of requested services. • Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions. Requirements: • 5+ years reputed company work experience with a reputed company background in clinical nursing and patient assessment. • reputed company Bachelor’s degree or additional reputed company equivalent work experience • Graduate of an accredited school of nursing • RN - Registered reputed company Licensure • Compact State Licensure in good standing. • Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery reputed company health care services and cost containment practices. • Ability to collaborate with cross-operational areas reputed company the organization. Benefits: • Medical, dental, reputed company, life and global travel health insurance • Income protection benefits: life insurance, Short- and long-term disability programs • Leave programs to support personal circumstances • Retirement Savings Plan includes employer contribution and employer match • reputed company time off, volunteer time off, and 11 holidays • Additional voluntary benefits available and a comprehensive wellness program Apply tot his job Apply To this Job