The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria. Candidate should have strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive in assisting customers to optimize their health, be able to adapt to business needs, be able to work in collaboration with a team and have strong communication skills.
Looking for a candidate with preferred managed care experience and a clinical background in obstetrics, gynecology, and medical surgical. The perinatal program is designed to offer health plan members the best maternity and postpartum care available. With perinatal interventions, routine services are supported and enhanced which will improve pregnancies and birth outcomes. The health plan identifies pregnant members as early in pregnancy as possible for outreach and encouragement to become engaged in healthy behaviors.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
Nursing/Licensed Social Worker (LCSW) is required
Functional - Nursing/Case Management/4-6 Years
Functional - Nursing/Maternal and Infant care/1-3 Years
Functional - Nursing/Medical-Surgical Care/Clinical/4-6 Years
Functional - Nursing/Mental Health/1-3 Years
Functional - Nursing/Pediatrics/1-3 Years
Functional - Disease Management/Medical Terminology/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/4-6 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years
Technical - Desktop Tools/Microsoft Explorer/1-3 Years