Case Management - Nurse, Senior

BSC
Los Angeles, CA
Category Healthcare
Job Description
The Senior Care Manager will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources, and will research and design treatment/care plans to promote quality of care, cost-effective health care services based on medical necessity.

Requirements

  • Research and design treatment/care plans
  • Initiation of timely individualized care plans
  • Determines appropriateness of referral for CM services
  • Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)
  • Conducts member care review with medical groups or individual providers
  • Manages member treatment to meet recommended length of stay
  • Assesses members health behaviors, cultural influences and clients belief/value system
  • Research opportunities for improvement in assessment methodology
  • Determines realistic goals and objectives and provides appropriate alternatives
  • Designs appropriate and fiscally responsible plan of care with targeted interventions
  • Assesses and re-evaluates health and progress due to the dynamic nature of the plan of care
  • Develops and implements the plan of care based on accurate assessment of the member and current of proposed treatment

Benefits

  • Retirement Plan
  • 401k Matching
  • Generous Paid Time Off
  • Tuition Reimbursement
  • Relocation Assistance
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