Case Manager II - 1001408
Position Purpose: Perform collaborative duties to assess and coordinate member care. Forecast potential financial exposure throughout the continuum of care in order to promote quality, cost effective outcome.
- Develop and implement comprehensive, cost-effective plans of care and conduct assessments/reassessments as needed or required
- Educate members and families about services/requirement and ensures member involvement in plan of care
- Authorize and coordinate referral for services and conducts assessments/reassessments
- Ensure provider services are delivered without gaps Coordinates community based service not covered by Medicaid for dually eligible members
- Monitor members care and condition, pharmacy utilization and prescription patterns
- Participate in discharge planning and conducts post-discharge follow-up
- Assist member with filing and resolution complaints and appeals
4+ years of combined clinical nursing and case management experience.
License/Certification: RN license.
Long Term Care
4+ years of combined clinical nursing and long term care, social work, or care coordination experience, preferably in a HMO setting.
License/Certification: Valid driver's license.
Job: Clinical & Nursing
Primary Location: USA-Massachusetts-Waltham
Organization: Health Plans