RN Care Manager

Job Responsibilities

• Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines.
• Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies.
• Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved.
• Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff.
• Evaluate and process member referrals from physicians to other specialty providers.
• Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met.
• Works with members and families on self-management approaches using coaching techniques such as motivational interviewing.
• Education the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes.
• Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality.
• Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
• Stay abreast of current best practices and new developments

Job Requirements

• Graduation from accredited school of nursing
• Bachelor’s degree in Nursing preferred
• RN licensure in the State of Wisconsin
• Case Management certification preferred
• Four years of clinical health care experience as a RN required
• Previous experience in case management, utilization management, insurance, or managed care preferred
• Experience with Medicare, Medicaid preferred