Under general supervision, responsible for identifying high risk patients for case management intervention and coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan, and community resources. Directs intervention with moderate to high risk members, and provides support and oversight to other team members managing low risk members. Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning and alternative treatment plan development. Initiates contact with patient/family, physician, and health care providers/suppliers to discuss the alternative treatment plan and conducts on-site or in-home evaluations as necessary. Monitors, evaluates, extends, revises or closes treatment plans as appropriate. Evaluates cases for quality of care. Communicates case management decisions. Understands and follows policies and procedures and produces and submits reports in a timely manner. Handles high acuity and complex cases. Serves as a professional resource to other Case Managers. Initiates and leads the multi-disciplinary care planning process.
Minimum Requirements: Current licensure as a Registered Nurse (RN) in PA or active license in a state allowing “multistate privilege to practice”. Three or more years experience in clinical and case management.
Preferred Requirements: Certified Case Manager.