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Senior Nurse Care Manager
3 months ago
Your Role
The Senior Nurse Care Manager will report to the Manager of Care Management and is responsible for coordinating care and support services relating to maternity and outpatient care. This role involves designing and implementing treatment plans, conducting member care reviews, assessing health behaviors, and collaborating with medical providers to ensure quality and cost-effective outcomes.
Your Work
- Research and design treatment /care plans to promote quality of care, cost-effective health care services based on medical necessity.
- Initiation of timely individualized care plans based on health risk assessment completion.
- Determines appropriateness of referral for CM services, mental health, and social services.
- Provides Referrals to Quality Management, Disease Management and Appeals and Grievance department.
- Manages member treatment in order to meet recommended length of stay.
- Assessment: Assesses members health behaviors, cultural influences and clients belief/value system.
- Planning: Designs appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes.
Your Knowledge and Experience
- Current RN License required.
- BSN or advanced degree preferred.
- Certified Case Manager (CCM) Certification or in process of completing certification.
- 5 years of prior experience in nursing, healthcare or related field required.
- 3 years experience in managed care preferred.
- Health insurance/managed care experience desired.
- Transitions of care experience desired.
Pay Range:
The pay range for this role is $87,230.00 to $130,900.00.
