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Case Managers assess, plan, implement, coordinate, monitor and evaluate options and quality health care services for individual consumers. The Case Manager is accountable for collaborating in an individual consumer's specific health care needs in a cost-effective manner and providing services across a continuum of care. Location: Seattle, Spokane, or Oregon, possibility to telecommute.
The Nurse Case Manager is responsible for performing the six essential activities of Case Management:
- Assessment: Collects in-depth information about the client's situation and functioning to identify individual needs in order to develop a case management plan.
- Planning: Determines specific objectives and goals and actions identified through the assessment process.
- Implementation: Executes specific intervention that will lead to accomplishing the goals of the case management plan.
- Coordination: Organizes integrates and modifies the resources necessary to accomplish the goals established in the case management plan.
- Monitoring: Gathers sufficient information from all relevant sources to determine the effectiveness of the case management plan.
- Evaluation: At the appropriate interval, determines the plan effectiveness in reaching desired outcomes and goals.
This position also:
- Completes screening process for all referrals according to current policy.
- Interviews client and family and obtains written consent for Level III and Level IV case management services.
- Communicates with payors and providers as appropriate.
- Provides consistent and accurate case documentation using FCH applications.
- Creates member correspondence using plain language and ensuring compliance with internal policies and procedures.
- Represents First Choice Health Network, Inc. in professional organizations or meetings.
- Completes month-end updates and case management notes for invoicing by the established date. Identifies and refers patients to behavioral health, stop loss, subrogation, quality and external vendors for health and wellness services based on the appropriate guidelines and payor requirements.
- Other projects or duties as assigned.
- Registered nurse with a current Washington State license.
- Minimum of five (5) years full time equivalent of direct clinical care to patients.
- CCM or related certification preferred or obtained within 24 months from date of hire.
- Strong physical assessment skills.
- Strong organizational, time management and interpersonal skills.
- Proficiency in PC applications including Word, Excel and Outlook.
- Preferred experience in an HMO, PPO or related health care industry
- Demonstrates analytical ability to identify problems, develop solutions and implement a course of action within an acceptable interpretation of departmental policies and procedures.
- Professional demeanor, functions well in stressful situations, and prioritizes well with minimal direction.
- Excellent problem-solving, negotiation and conflict resolution skills.
- Ability to demonstrate strong written, verbal and interpersonal communication skills with varying levels of internal and external agencies and medical professionals.
Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.Click here to learn more about our competitive benefit package.
How to Apply
Please submit your resume to email@example.com.
Additional information about our company may be found on our website www.fchn.com