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Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs.
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Oversee smooth Transitional Care Management for all patients discharged from in patient facility (hospital, skilled nursing/rehab, behavioral health) ensuring: Primary Care Provider visit, DME and Home Health Services, Specialist appointments, and community resources/social services are provided as indicated.
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Depending on where your Care Manager is located, you may notice expert care given in support of an end-of-life journey, a significant transition from home to the next level of care, therapy provided to support a mental health journey or life change, or special attention to a certain diagnosis that needs education, support, and resources to improve a patient's overall health outcome.
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Risk Management- Proactively ensures that individuals identified as a Special Needs enrollee that have treatment needs or require regular monitoring have a Behavioral Health Clinical Home and a Medical Home. Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider’s crisis plan.
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TheSpecial Programs Case Manager Iis responsible for performing case management telephonically and/or by home visits within the scope of licensure for special programs, such as Foster Care. Manages overall healthcare costs for the designated population via integrated (physical health/behavioral health) case management and whole person health.
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As an RN Care Manager, you need to know how to:Perform comprehensive assessment of patients health needs, including health status and behaviors, level of function, psychosocial situation, and available support systems and determines potential needs.
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Advocate for Members to receive the highest quality care, in a timely manner, within the company's network by making appropriate referrals to Behavioral Health, Enhanced Care Management, and Complex Care Management.
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Conduct comprehensive assessments that include the medical, behavioral, pharmaceutical, and social needs of the patient, identify gaps in care and barriers to good health; The RN Care Manager is expected to conduct approximately 12 assessments per week and manage a panel of about 150 assessed patients.
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Communicate and coordinate with internal stakeholders to identify and address patient needs (e.g., care team, social work, behavioral health, utilization management, Hard-to-Reach, Central Telehealth, etc.
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The RN Care Manager is a critical member of the care team consisting of nurses, dietitians, pharmacists, social workers, community health workers, and physicians. Based on this assessment, and in conjunction with the patient, patient’s nephrologist & PCP, and other members of the care team, create and implement a care plan that will address identified needs, remove barriers to care, and improve the health of the patient.
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Collaborate and communicate with the enrollee's other medical, behavioral health and home-based providers regarding changes in services, hospitalizations, and other care needs and goalsObtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary services.
$90,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
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We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. The Care Manager II (RN/LICSW) assists members with complex medical needs appropriate for care coordination and case management services in achieving their optimal level of health through self-management.
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Eliot's One Care Health Home program is an innovative Care Management approach for members with complex medical, behavioral health, and social needs who are dual eligible, having both Masshealth and Medicare benefits.
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MINIMUM EXPERIENCE: 3-5 years of experience with primary care/ambulatory care, home health agency, Behavioral Health, skilled nursing facility, or hospital medical-surgical, within the past five years.
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home care behavioral health jobs Title: care manager in WA, Ohio
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