Case Manager - Registered Nurse (EST)

Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel. Implements and coordinates case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care visits, community resources, and alternative levels of care. Interacts with members telephonically or in person, including home visits, worksite visits, or physician's office visits. Assesses medical/vocational status, develops a plan of care to optimize wellness and medical outcomes, and facilitates timely return to work or optimal functioning. Communicates with stakeholders telephonically or in person. Documents case work activities. Consults with internal multidisciplinary team. May outreach to treating physicians. Provides educational and prevention information. Applies laws and regulations. Evaluates needs and benefit plan eligibility using clinical tools. Utilizes case management processes in compliance with policies. Monitors progress toward desired outcomes.