Offer summary

Qualifications:

Current unrestricted RN license in applicable state(s) required., High school diploma or equivalent., Minimum of 2 years of experience in a relevant field., Completion of a Tuberculosis test is required for this position..

Key responsibilities:

Manage quality, cost-effective care using selective benefits and alternative services for members.

Collaborate in the patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate health services.

Support members regarding care transitions and changes in health status.

Implement and revise comprehensive clinical case management plans for patients.

Job description

Job Description Summary

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Responsible for managing quality, cost effective care using selective benefits and alternative services best suited for the member.

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How will you make an impact & Requirements

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CareMore Care Manager

With nearly 30 years of experience in providing advanced primary care, Carelon APC delivers exceptional patient experiences. Compassionate clinicians take the time to understand each patient’s unique health needs while also removing barriers to access. Patients trust us to receive the right personalized care where and when they need it – in our care centers, at home or virtually – to improve their health outcomes and quality of life.

Manage quality, cost-effective care using selective benefits and alternative services best suited for the member. Collaborate in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members' health needs.

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How will you make an impact & Requirements

Job Description Responsibilities:

Manage quality, cost-effective care using selective benefits and alternative services best suited for the member.
Collaborate in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members' health needs.
Support members or their representatives regarding care, care transitions, and changes in health status.
Implement a comprehensive clinical case management plan for each patient.
Obtain input from providers, patients, and families as appropriate, and evaluate and revise the plan as needed.
Analyze patient variances from the plan and initiate appropriate steps to resolve variances.
Perform admission and concurrent stay reviews on hospitalized patients.
Develop and implement discharge planning for patients in conjunction with hospital-based case managers.
Perform telephonic, fax, and/or on-site reviews with skilled nursing facilities, home health agencies, or other contracted service agencies to determine the need for continued care.

Qualifications:

Current unrestricted RN license in applicable state(s) required.
High school diploma or equivalent.
Minimum of 2 years of experience; or any combination of education and experience which would provide an equivalent background.
For Carelon Health business units, satisfactory completion of a Tuberculosis test is a requirement for this position.