RN Care Manager - Occasional - Days




Department: CARE MANAGEMENT SERVICES



Job Summary

The Care Manager is responsible for completing a comprehensive assessment to determine the correct services and benefits based on medical necessity for an enrollee. Provides plan education, transition of enrollees to clinical services based on Department of Health (DOH) guidelines. Care management providing advocacy, coordination and oversight of all healthcare services for an enrollee striving to deliver the best care at the right time and in the most-cost effective while meeting quality outcome standards for the enrollee case load assigned. Complies with all state and federal regulations including Health Insurance Portability and Accountability Act (HIPAA).


Core Job Responsibilities
+ Identifies and coordinates enrollee services as provided by the plan and services that are not a benefit of the plan (Medicare Services).