Field Case Manager Nurse RN - Columbus, GA - Full-time / Part-time

Case Manager will coordinate and/or provide appropriate level of care under the direct supervision of an RN or MD.  The position will be responsible for clinical and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating).  This includes case management, coordination of care, and medical management consulting.  Function may also be responsible for providing health education, coaching and treatment decision support for members.

This is a field based position traveling to provider offices in the Columbus, GA area.  You will be responsible to review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention.  You will be working at the provider office on a daily basis.  This position is Monday - Friday during business hours.

Responsibilities:

• Primarily provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation


• Conducts face to face and telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols


• Determines member's overall bio-psychosocial needs and develops individualized member service/care plan based on assessment data, member and caregiver/ stakeholder input, and cost-effective options for service delivery


• Provides options and choices for long –term care community or facility-based service delivery


• Develops member goals in coordination with member and provider


• Routinely and as needed evaluates the effectiveness of the care/service plan and makes appropriate revisions per policy & procedure/ state contractual requirements


• Facilitates care setting transitions and access to special programs (e.g. Hospital to Home, Advanced Illness, transition from Nursing Facility to community setting)


• Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness


• Coordinates benefits through other available payment sources


• Assists the member to access community, Medicare, family and other third-party resources as appropriate


• Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member


• Provides education to members regarding health care needs, available benefits and services


• Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care


• Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address


• Documents all care coordination activities and interventions in the member's health plan clinical record


• Maintains a focus on timely, high-quality customer service


• Maintains the confidentiality of all sensitive information