Nurse Case Manager II

Job Responsibilities: Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.Services strategies policies and programs are comprised of network management and clinical coverage policies.Coordinates and implements assigned care plan activities and monitors care plan progressConducts multidisciplinary review to achieve optimal outcomesIdentifies and escalates quality of care issues through established channelsUtilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needsUtilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of healthProvides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choicesHelps member actively and knowledgeably participate with their provider in healthcare decision-makingMonitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and proceduresDevelop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.Services strategies policies and programs are comprised of network management and clinical coverage policies.Coordinates and implements assigned care plan activities and monitors care plan progressConducts multidisciplinary review to achieve optimal outcomesIdentifies and escalates quality of care issues through established channelsUtilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needsUtilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of healthProvides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choicesHelps member actively and knowledgeably participate with their provider in healthcare decision-makingMonitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Skills: Bi-Lingual Spanish/ English preferredBi-Lingual Spanish/ English preferred Education/Experience: RN with current unrestricted state licensure.RN with current unrestricted state licensure. #J-18808-Ljbffr