Case Manager Nurse RNPrimary Location: Dallas, TX
Additional Locations: TX-Dallas Apply
The Nurse Case Manager is responsible for the telephonic assessment, planning, implementing and coordinating of all case management activities in order to evaluate the member's medical needs and to facilitate the member’s overall wellness. Along with the member, the Nurse Case Manager develops a proactive plan of care to address the issues presented in order to enhance the short and long-term outcomes, and to enhance the member’s overall wellness. The Nurse Case Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
68618Fundamental Components: This position is telephonic in a fast-paced production environment. The Nurse Case Manager will both outreach and receive calls from members, educate members on their disease processes, educate members on preventative care and wellness, collaborate care with providers, and assist members with their needs. The Nurse Case Manager applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers, and to address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions, including co-morbid and multiple diagnoses that impact functionality. The case manager reviews prior claims to address potential impact on current case management and eligibility; consults with supervisor and others in overcoming barriers in meeting goals and objectives; presents cases at case conferences for multidisciplinary focus to benefit overall claim management; and utilizes case management processes in compliance with regulatory and company policies and procedures. The case manager employs motivational interviewing skills to ensure maximum member engagement and to discern their health status and health needs based on key questions and conversations. There may be some need for travel for face to face visits with members. Background Experience:
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