Mobile, United States
11 months ago
This position is accountable for leading, directing and overseeing a team of nurse case managers. Specific responsibilities include, but are not limited to: identifying cost-effective protocols for high-risk, high-cost diagnoses; and, developing and administering guidelines for working with employees, employers, policyholders, healthcare providers, patients, and families to determine appropriate, cost-effective care plans. Provides coaching and clinical supervision.
Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Manages own caseload and coordinates all assigned cases. Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.