Actalent Nurse Case Mgr I in Des Moines, Iowa
The use of this job is limited to non-CareMore business units. If you believe this to be the best match for your position, please consult with your Human Resources partner prior to using this job. Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. Primary duties may include, but are not limited to: Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Requires a BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred. For URAC accredited areas the following applies: Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. 5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
case management, clinical care, Medicaid
Additional Skills & Qualifications:
Need Iowa RN License - Active
Preferred candidates have at least a AS in Nursing but open.
1+ years of clinical experience
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