The RN Care Manager works within a multidisciplinary team to help identify and manage members who are in need of additional nursing care or support in their home to improve their quality of life.Through the nurse's interventions such as complex case management and utilization management, the RN Care Manager will ensure coordination of health care services, member education, and preventative intervention
· The Registered Nurse provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
· The Registered Nurse develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member’s care.
· The RN Care Manager initiates utilization review for preauthorization and post service reviews
· The RN Care Manager utilizes knowledge of community resources and the member’s benefit structure
· The Registered Nurse Care Manager recognizes quality of care issues and escalates the issues appropriately
· The Registered Nurse Care Manager assists members with the coordination of services from various settings as appropriate
Fluency in one of the following languages:
REQUIRED LICENSE OR CERTIFICATIONS:
Who We Are: Centers Care Solutions (CCS), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CCS is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community.