RN Case Manager

🤖 Medical and Behavioral Case Manager/ $65k-$85k Great Place To Work!

  • Fargo, ND
  • $65,000 - $85,000
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A bit about us:

Company is committed to connecting our members to the best care and wellness tools—at the best price. Our dedication to this work began in 1940, when the company was started to help people get health care they couldn’t afford during the Great Depression. Now, as we enter a new era of health care, we continue our mission of delivering affordable solutions to improve the care and health of our members.

Why join us?

Nationwide leader in the provider space! 2022 Most Engaged Workplace!

Great benefit package, strong compensation, PTO, 401k and company culture!

Job Details

JOB SUMMARY

The Medical and Behavioral Case Manager reviews cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources (e.g. Medical Review) to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.

ESSENTIAL FUNCTIONS

  • Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention. Develops, coordinates and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan.
  • Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member. Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.
  • Collaborates in identifying appropriate alternatives to the present care and providing assistance with identified needs by collaborating with the member and member’s health care team.
  • Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.
  • Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.
  • Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.
  • Throughout the case management process, collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member’s care.
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Job Details
Managed by Jobot Pro
Location
Fargo, ND
Job Type
Permanent
Compensation
$65,000 - $85,000