Care Manager II, Registered Nurse

Responsibilities:

The Care Manager II assists members appropriate for care coordination and case management services in achieving their optimal level of health.  The Care Manager II is responsible for engaging the member and providers to assess, plan and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources.  The position will function as a single point of contact and be an advocate for members in the care coordination program. Assess members to determine care coordination and case management needs for all referred members.  Completes comprehensive assessment of environmental, Psycho-social and support needs. Identifies problems/barriers for care coordination and appropriate care management interventions.     Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health. Identifies both short and long term goals and associated time frames for completion.  Shares goals with the member and family as appropriate.    Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress. Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues.  Documents progress towards meeting goals and resolving problems. Coordinates care and services with the Account manager, Complex RN Case Manager, and member, family members as appropriate, PCP, Specialist, and Facility/Vendor Providers.

Education/Experience:

• Current and unrestricted Registered Nurse licensure in Pennsylvania.
• Associates Degree in Nursing. 
• Minimum of 3 years clinical practice experience in med-surg and/or home care required. Experience wtih pediatrics and behavioral health desired.
• 3-5 years experience as a case manager, preferably providing telephonic case management within a managed care organization, preferred.
• Certification as a case manager (as documented and accepted on URAC’s website@ www.urac.org) preferred.
• Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs.
• Ability to meet deliverables within designated timeframes; strong organization and communication skills.
• Valid driver’s license with car insurance