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The ideal candidate for this position will be a Registered Nurse (RN) with Medicare / Medicaid experience. A CCM (Certified Case Manager) is strongly preferred. The position entails managing complex cases.
The Medical Case Manager manages and tracks all members who require a comprehensive approach to immediate and ongoing care of their complicated and/or catastrophic illnesses. This position also coordinates care for all members experiencing a care transition from one level of care back to their residence. The Medical Case Manager documents interactions with and on behalf of the member throughout service delivery including, but not limited to: care plans, progress notes, assessments, correspondence, and authorizations.
This individual will provide Case Management services to referred members. Act as a liaison to facilities, providers, and/or members related to issues in case management and care services. Identify member needs and address these needs to remove any barriers in achieving optimal behavioral health and medical care. Educate members on the importance of good health and following up with the Primary Care Physician on a regular basis. This individual will identify members who had a recent transition of care and assist with follow up and discharge needs. He/she will monitor members identified through the High Utilization of ER Services Reports.
High School Diploma or GED
Associate's degree or Bachelor's degree from an accredited nursing program
Active, current, valid and unrestricted Arizona State Registered Nurse license
At least two (2) years in a health care setting
Experience coordinating patient care
HMO/Managed Care/Medicare/Medcaid experience
Knowledge of Medicare and Medicaid regulations and guidelines
Knowledge of professional and community based resources
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Job Type: Full-time