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High Intensity Case Manager, RN
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Full-time
- The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members’ medical, environmental and psychosocial needs are optimize over the continuum of care.
- Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
- Develop Individual Care Plan (ICP) by conditions identified in health plan HRA, patient assessment, medical records authorizations/referrals, primary care physician, member, and Interdisciplinary Care Team (ICT).
- Case Manager’s ability to effectively manage a panel/caseload of high-risk members in collaboration with Nurse Practitioner, Pharmacist, PCP, SPC, health plans and other ICT members.
- Collaborate with member’s family and physicians for seamless coordination of care and services|Collaborate and coordinate care with Health plans, Community Based Programs (CBAS), Managed Long Term Supportive Services (MLTSS) and Behavioral Health Providers|Monitors and evaluate effectiveness of the care management plan and modify as necessary based on members’ progress, changes in condition and to minimize unnecessary utilizations, admissions, and readmissions.
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