Case Manager II 8/31/2016

MMS Group Eugene, OR

Company
MMS Group
Job Classification
Full Time
Company Ref #
29461931
AJE Ref #
576044865
Location
Eugene, OR
Job Type
Regular

JOB DESCRIPTION

APPLY
Care Manager II (RN)

Join an innovative health plan that values their nurses! Care Manager will perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
* Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
* Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
* Coordinate services between PCP, specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
* Provide patient and provider education
* Facilitate member access to community based services
* Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
* Actively participate in integrated team care management rounds
* Identify related risk management quality concerns and report these scenarios to the appropriate resources.
* Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
* Direct care to participating network providers
* Participate in case management committees and work on special projects related to case management as needed

Qualifications

-Minimum of Associate's degree in Nursing.
- 2+ years of clinical nursing experience in an acute care setting
- 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care.
-Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed health plans.
- Current Oregon RN license.
- Must be willing to work fulltime on site - no home based