Case Manager Specialty RN - Population Mgt

Works collaboratively with an assigned panel of physicians to manage patients' specialized needs. Duties include assessment to identify member needs, development of care management plans, coordination of access to health services across multiple providers, monitoring care, arranging transportation and transfer if indicated, identifying cost-effective measures, making recommendations for alternative levels of care, promoting self-care management, and completing paperwork. Acts as an indirect caregiver and works with a multidisciplinary team. Evaluates and identifies member needs, interfaces with PCPs and specialists, monitors and evaluates care plans, coordinates interdisciplinary continuity of care including utilization management, transfer coordination, discharge planning, and obtaining authorizations. Acts as clinical liaison with outside agencies, prepares reports, develops protocols, advocates for patients, develops individualized education plans, facilitates return to normal activities, consults with providers and discharge planners, coordinates transmission of clinical and benefit information, participates in data collection and outcome analysis, and interprets regulations and health plan benefits.