Case Management - Nurse, Senior (Population Health)

The Senior Care Manager will report to the Manager of Care Management and ensure that services are provided based on standardized procedures, including coordination of care with specialists and community resources.

Requirements

• Research and design treatment/care plans
• Initiation of timely individualized care plans
• Determines appropriateness of referral for CM services, mental health, and social services
• Provides referrals to Quality Management, Disease Management, and Appeals and Grievance department
• Conducts member care review with medical groups or individual providers
• Manages member treatment to meet recommended length of stay
• Ensures DC planning at levels of care appropriate for the members needs and acuity
• Assesses members health behaviors, cultural influences and clients belief/value system
• Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines
• Research opportunities for improvement in assessment methodology and actively promotes continuous improvement
• Develops and implements the plan of care based on accurate assessment of the member and current of proposed treatment