Shift for this role is either Monday- Friday 9:00 am- 5:30 pm OR 10:00 am – 6:30 pm.
Major responsibilities and desired results:
- Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.
- Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history and current status and to assess the options for optimal outcomes.
- Promote consumerism through education and health advocacy.
- Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
- Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
- Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
- Negotiates price, level of care, intensity and duration with provider(s), as appropriate.
- Acts as a timely and proactive liaison between account, client/family, physician(s) and facilities/agencies
- Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
- Compliant with all accreditation, State and Federal mandates
- Delivers utilization review services when member is in active case management as appropriate
- Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Demonstrates sensitivity to culturally diverse situations, clients and customers.
- Based on experience, may provide leadership, preceptor/mentorship, support and coverage to other case management staff and assist case managers in achieving positive outcomes and savings
- Engage our CAC partner (Embedded Care Coordinator) to support service to our customers.
- Participates in committees, task forces and other company projects as assigned and other assigned tasks as deemed necessary to meet business needs.
- Other duties as required and related to this role
- Active unrestricted Registered Nurse (RN) license in state or territory of the United States
- Three years full-time equivalent of direct clinical care to the consumer required
- MUST live in or near Plano, TX
NOTE: This role will be work at home until the COVID 19 bans are lifted and it is safe to return to an office environment. After the pandemic this role will be office based in Plano, TX.