The client's Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
• Utilizes a collaborative process of assessment, planning, implementation and evaluation to engage, educate, and promote members' decisions related to achieving and maintaining optimal health status.
• Functions in an independent manner for member care planning.
• Typically works with members with the most complex clinical needs.
• Conducts standardized Health Risk Appraisals (HRA) and applicable assessments, including the verification of medical history and current health and wellness needs.
• Expected to meet daily production standards in terms of member outreach.
• Utilizes a web-based software system to document all assessments, activities and education provided.
• Develops a problem list and individualized care plan using program protocols based on the members needs and preferences.
• Conducts telephonic education to promote self-management strategies for all applicable conditions.
Graduate from an Accredited School of Nursing.
Bachelor's Degree in Nursing preferred.
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
1 years in case management, disease management, managed care or medical or behavioral health settings.
Preferred License, Certification, Association
Certified Case Manager (CCM)