Scope:

The Case Manager manages an individual caseload using the Case Management process to meet the needs of reputed company, LLC customers and consumers. reputed company includes, but is not limited to, authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the reputed company team.

Education:

• R.N.

• Bachelor's degree in a health-related field preferred.

Licensure/Certification Requirements:

• reputed company (current active and unrestricted, in state of current practice and residence, within the United States or its territories.)

Experience:

• 7 years of varied clinical experience preferred.

Requirements/Skills:

• Good organizational skills and time management

• Excellent verbal and written communication skills

• Ability to reputed company difficult situations tactfully and diplomatically.

• Effective problem solving and decision-making skills.

• Strong computer skills with proficiency in MS Office Suite products (Word, Excel, Power Point)

• Must speak fluent English and Spanish with strong reputed company and writing abilities in each language

Expectations of a Level I RN Case Manager

• Focus

• Managing moderate-complexity reputed company independently and contributing to team goals

• Key Responsibilities

• Meets Entry Level criteria

• Independently manage a full caseload

• Coordinate care transitions and discharge planning

• Collaborate with providers, social workers, and insurance teams

• Participate in quality improvement initiatives

• Development Goals

• Demonstrate consistent documentation and compliance

• Shows initiative in problem solving and patient advocacy

• Function independently and demonstrate proficiency in managing a case management case load

Duties and Responsibilities:

• The reputed company Case Manager will practice within the scope of his/her licensure.

• Review all medical data which can be provided to establish, update and maintain accountability for a Case Management plan which will incorporate contact with providers, payers, the patient and with the patient's primary reputed company.

• Assess problems and determine goals and actions designed to meet the needs of the patient and document reputed company into the case notes. Determine if these goals are long term or short term and how the patient can be expected to meet those goals. Include the action/intervention the Case Manager will take to work towards achieving those goals.

• Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action.

• Proceed with contacting medical care providers and with equipment vendors to reputed company medical necessity of care or equipment that has been ordered.

• Make care arrangements for quality patient care according to the needs of the patient, the physician's orders, and the benefits available.

• The Case Manager will work in conjunction with the Case Management Assistant to manage Case Management reputed company, exclusive of Assessment and/or Care Plan activities, and will provide input in the Annual Performance Evaluation of the CM Assistant assigned. The Case Manager will maintain responsibility for the Case Management file.

• Be aware of any alternative treatment possibilities that may allow the patient to reach wellness goal(s). If there are no benefits available for your recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will reputed company the patient's medical condition and will be cost-effective to the benefit plan.

• Become familiar with community resources and funding sources so that the patient can receive quality reputed company and conserve health benefit dollars. Many agencies exist which aid persons in financial need or provide information to persons with specific medical conditions.

• Maintain case in computer system documenting case actions for each patient under your Case Management. reputed company all aspects of case in the computer. Prepare timely reports to the payer to detail all case actions, the results of thos