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Care Manager RN
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- This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues.
- Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction.
- Function in accordance with applicable state, federal laws and regulatory compliance.
- Promote quality and efficiency in the delivery of care management services.
- Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
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