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RN Case Manager

ESCRIPTION JOB TITLE: Nurse Case Manager REPORTS TO: Case Management Supervisor   POSITION SUMMARY:   Case management, coordination and authorization of care. Leads team discussions. Supervises Member Services Representative. Principal Duties and Responsibilities: 1. Provides case management including coordination, authorization and tracking of patient care via the plan of care. 2. Provides authorization to service providers and tracks services. Evaluates the effectiveness of the services and makes revisions based on the patient’s changing needs in collaboration with the enrollee and physician. Obtains orders for changes in the plan of care. 3. Provides on-going assessment of the effectiveness of the case management program and provide ongoing follow up with the enrollee, family, caregivers, and physician. 4. Discusses and develops a comprehensive Plan of Care in collaboration with the physician, and by assessing and identifying the clinical, psychosocial and financial needs of the patient/family/caregivers and establishing mutually agreed upon goals. Obtains verbal and written orders from the physician. 5. Monitor and evaluates patient care plans and services delivered by the Network Providers for quality, cost effectiveness and appropriateness through direct observation, documentation review, and conferences. 6. Leads team conferences and coordinates interdisciplinary care planning, in accordance with physician’s orders. Discusses enrollee status with the other members of the health care team. 7. Initiates referrals for services to appropriate Providers and coordinate the ongoing provision of services. 8. Supervises the Member Services Representative. 9. Collaborates with finance department, claims processing agency and managers on services that are authorized and/or denied. 10. Charts all contacts and findings on designated forms as per Policy and Procedure. 11. Participates in “on Call" assignments and weekend scheduling. 12. Promotes effective interpersonal, interdisciplinary team relationships. 13. Performs other duties as assigned.       QUALIFICATIONS:       1. Currently licensed to practice as a Registered Professional Nurse in New York State. 2. Associates Degree in Nursing, BSN preferred. 3. Two years’ professional experience in a managed care or home care setting. Experience in office-based case management highly preferred. 4. Ability to work with and motivate others.

Champaign, Illinois