Description: Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs Provide patient and provider education Facilitate member access to community based services Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan Actively participate in integrated team care management rounds Identify related risk management quality concerns and report these scenarios to the appropriate resources Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
Associated topics: asn, cardiothoracic, ccu, domiciliary, infusion, intensive care, nurse, nurse clinical, recovery, unit