Case Manager - RN Ambulatory

Job description

The Case Manager 1 directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. Experience - 3 years of general or specialty nursing practice - Individual High Risk Care Management - Assists health plan member to set realistic goals using system tools and judgement. Gain trust to assure disease based, high risk or high utilization individuals set and meet or exceed targets. - Consistently measures and communicates with the individual on goal status and documents progress and measures of improvement using system tools. Process includes constant communication, psycho-social skills and disease management care plans such as obesity, diabetes and hyperlipidemia. - Coordinates care team around individual to assure obstacles to goals are removed including such activities as mak...