The Case Manager Registered Nurse plans and coordinates care management services for members, coordinates benefits and collaborates with the Medical Director, MLTC Care Manager, Primary Care Provider, Social Worker and Clinical Services Associate to develop, implement and monitor the plan of care for ArchCare Advantage members. Monitor effectiveness of the care plan and promote member wellness and self-management as well as member satisfaction with the service provision.
The candidate will have proven working experience in case management, including as a nurse, medical care manager or a related job. Excellent knowledge of case management principles and Medicare/Medicaid reimbursement including National and Local Coverage Determinations. Familiarity with Millman & Roberts or Inter-Qual Criteria, knowledge of discharge planning and home care service management. Excellent organizational, time management and communication skills a must.