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Case Manager RN | AMERIGROUP Virginia, Inc. | Hanover, MD
JOB SUMMARY:
The Case Manager RN is responsible for managing members
experiencing complex or catastrophic illness, injury and/or specialty
illnesses such as diabetes, HIV, transplant, etc, to insure cost
effective and efficient utilization of health services. She/he acts as
a member advocate, seeking and coordinating creative solutions to
member's health care needs without compromising quality of outcomes
PRIMARY RESPONSIBILITIES:
- Obtains an accurate member history.
- Assesses clinical information to develop care plans including a
member support system.
- Establishes short and long term goals in collaboration with the
member that meet the member's needs and the referral source's
requirements.
- Establishes working relationships with referral sources and community
resources.
- Communicates care objectives to appropriate
individuals/departments/referral sources.
- Assessment of biopsychosocial factors.
- Identifies members with potential for high risk complications and
coordinates the appropriate treatment in conjunction with the member and
the health care team.
- May be required to conduct field visits.
- May be required to perform Pre Certification duties and
responsibilities as assigned and required by the Plan
- Acts as an advocate for an individual's health care needs.
- Reviews benefit systems and cost benefit analysis.
- Evaluates the quality of necessary medical services.
- Utilizes criteria for authorizing appropriate clinical services.
- Identifies members that would benefit from an alternative level of
care.
- Acquires data and evaluates necessary health services for cost
containment.
- Documents effectiveness of case management services.
- Identifies the need for assistive devices/adaptive equipment needed
for members.
- Conducts skills assessment, planning, implementation, coordination,
monitoring and evaluation.
- Requests direction from appropriate supervisor(s) on complex issues.
- Utilizes leadership skills for non-clinical team members.
- Collaboratively works with other departments.
- Participates in Quality Improvement processes.
- Serves on internal and external committees.
- Maintains member confidentiality.
- Other duties as requested or assigned.
EDUCATION AND EXPERIENCE:
Education
Required:
- RN required with four years experience in health care, case
management, discharge planning or behavioral health.
- Current State RN license to practice Nursing.
Preferred:
- Bachelor's or Master's Degree
Years and Type of Experience
Required: Experience working on the community level and with
community agencies preferred.
Certifications or Licensure
Required:
- Certified case managers preferred.
- Must possess a valid driver's license and access to a motor vehicle.
Other
Required:
- Computer literate.
- Excellent verbal and written communications skills.
- Strong decision making skills.
- Ability to provide services in an environment that involves multiple
health care systems.
- Ability to interact with all relevant components of the health care
system.
- Ability to provide services that deal with the individual's broad
spectrum of needs.
- Self-starter with ability to handle multiple projects at one time.
- Appreciation of cultural diversity and sensitivity towards target
population.
- Bilingual a plus.
PHYSICAL REQUIREMENTS:
- Must be able to operate a computer.
- Must be able to operate (and communicate via) a telephone.
- Must be able to sit for long periods of time
In accordance with state and federal laws, employment offers are
tendered solely on the basis of qualifications without regard to race,
religion, color, national origin, age, sex, marital status, sexual
orientation, handicap (including disabled veterans) or Vietnam Era
veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of
employment and a satisfactory criminal history background report.
To apply for this position, please copy and paste the following link
into your browser address bar:
http://amerigroup.contacthr.com/14053592
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