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Oversees and ensures overall PACE program quality and effectiveness, including identifying the need for services and innovative ways to provide care, improving efficiency and effectiveness, and responding to participant and community needs.
The primary responsibility of the Nurse Case Manager is to conduct health assessments, and then coordinate and monitor the care of Health Plan members and develop a nursing plan of care.
The utilization review nurse will obtain the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs.
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