Nurse Case Manager
Posted on: May 28, 2023
- Provide comprehensive healthcare management services to
facilitate appropriate healthcare treatment, effectively manage
healthcare costs and improve healthcare program/operational
efficiency involving clinical issues.
- Facilitates optimal outcomes. Identifies and follow through
with continuous quality/ compliance opportunities.
- Educates/ empowers members to ensure compliance, satisfaction
and promote patient advocacy.
- Through the use of clinical tools and information/data review,
conducts an evaluation of member's needs and benefit plan
eligibility and facilitates integrative functions as well as smooth
transition to client programs and plans.
- Applies clinical judgment to the incorporation of strategies
designed to reduce risk factors and barriers and address complex
health and social indicators which impact care planning and
resolution of member issues.
- Assessments consider information from various sources to
address all conditions including co-morbid and multiple diagnoses
that impact functionality.
- Reviews prior claims to address potential impact on current
case management and eligibility.
- Assessments include the member's level of work capacity and
- Using a holistic approach assess the need for a referral to
clinical resources for assistance in determining
- 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
- Utilizes case management processes in compliance with
regulatory and company policies and procedures.
- Utilizes interviewing skills to ensure maximum member
engagement and discern their health status and health needs based
on key questions and conversation.
Keywords: ICONMA, Richmond , Nurse Case Manager, Healthcare , Richmond, Virginia
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