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Job Title:
Nurse Case Mgr I, II (Telecommuting Option) .
Employer:
Availability to work from home after 1 year of onsite work
Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs. Essential duties may include, but are not limited to: Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment
plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures. Performs other duties as assigned.
Qualifications .
Requires bachelors degree or higher in a health related field and licensure as a health professional, or certification as a care manager, or unrestricted RN licensure in applicable states and 5 years clinical experience. Requires knowledge of health insurance/benefits. Requires knowledge of care management assessment technique, provider community, and community resources. Three years experience in home health/discharge planning preferred. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, and decision-making skills. .
June 2007
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Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 07/26/2007
System Time: 21:10:40
Document Name(40): Nurse Case Mgr I, II (Telecommuting Opti
Source: Indeed - USA
SearchTerms: "work at home" "work from home"
URL(80): http://www.indeed.com/rc/clk?cd=HONJUsEBfVdyVvA3hejM87zu3ZZzIBFwC2m5MV7al_QM3Lro
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