RN Case Manager

3-5 years relevant experience in a variety of appropriate clinical health care settings (Inpatient, outpatient, or differing levels of care).

Utilization Management experience, preferred

The Role The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health.

Facilitation is focused on assessing needs, identifying health care disparities, social determinants of health, and any barriers to care.

Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively and provide members with education and resources as needed.Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.

Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans.

Review medication list and educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.

Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes.

The Team The Clinical Care Manager is part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical directors and more, who collaborate to facilitate care.