RN Case Manager
JOB TITLE: Nurse Case Manager
REPORTS TO: Case Management Supervisor
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.
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.
AXION is a dynamic and innovative staffing organization determined to exceed both our candidate's and our client's highest expectations. Over the last three and a half decades, Axion has been the preferred staffing solution for thousands of companies in the New York, New Jersey and Pennsylvania markets. Axion continues to provide these services and has been certified by The Joint Commission. Axion is an Everify company.
The Company is an equal opportunity employer and complies with all applicable laws prohibiting discrimination and harassment. The Company will recruit and hire all persons without regard to race, color, sex, religion, national origin, age, marital status, sexual orientation, disability, veteran status or any other basis prohibited by federal, state or local law. Further, all personnel actions such as compensation, promotions, benefits, transfers, layoffs, company-sponsored training, education, tuition assistance, terminations, social and recreational programs will be administered in the same manner.
The Company views the principles of equal opportunity as a vital element in the employment process and as a hallmark of good management. Assuring equal employment opportunity is a function and direct responsibility of all levels of management. All managers and supervisory personnel are charged with making a personal commitment to practice and enforce the principles of this policy.
We are an equal opportunity employer M/F/D/V
White Plains, NY
Fri, 21 Jul 2017 06:11:51 PDT