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RN Care ManagerMargate, FL, USA Req #525 Monday, October 3, 2022Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.Primary Responsibilities: Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member’s care.
Initiates utilization review for preauthorization and post service reviews
Utilizes knowledge of community resources and the member’s benefit structure
Interacts with providers and facilities in a professional, respectful manner
Recognizes quality of care issues and escalates the issues appropriately
Assists members with the coordination of services from various settings as appropriate
appropriate
Complies with all CCSs standards for documentation
Participates in case rounds
Participates in on call coverage
Participates in other meetings as requested
Participates in quality improvement initiatives
Other duties as assigned
Required:Active and unrestricted NYS RN license
Strong written and verbal communication skills
Preferred:Bachelor of Science in Nursing
CCM certification
Knowledge of Milliman or InterQual criteria
Experience providing care in the home setting
Experience working within a managed care environment
Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.Other detailsPay Type Salary
Apply NowMargate, FL, USA
Vacancy expired!