The Case Manager coordinates the care and services of selected member populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes.
The Case Manager must be able to effectively assess and coordinate member’s needs; maximize their available benefits; assist in creating a cost effective plan of care; and identify high risk and high utilization cases. Assigned cases may include components of medical, behavioral health, disease management, complex case management, and/or concurrent (Utilization Review) review.
RN with a BSN or a Bachelor’s prepared Licensed Behavioral Health Clinician for community based case management teams required.
RN with a BSN for Hospital Review Case Management team is required.
If RN candidate is not BSN prepared must be willing to sign an education agreement upon hire to complete BSN within 60 months of hire date, otherwise will not be considered.
Three years current experience in acute care nursing, case management, UR/UM, discharge planning, clinical psychiatric setting, or related experience, such as disease management, hospice/home health or community/public health is required.
Licensure by the Commonwealth of Virginia as a Health Care Professional is required. One of the following certifications (ACM, CCM, CMCC) is required upon hire.
If not certified at the time of hire it is required that the certification will be obtained within one (1) year of eligibility.
Basic knowledge of Microsoft Office applications is required. Ability to send an email and research the internet is required.
Optima Health - 17 months ago
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