About the Role
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 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 the 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.
Requirements
Current, active unrestricted RN license in the state of Indiana
· BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
· OB nursing experience is strongly preferred.
· Case management experience.
· Previous managed care experience preferred.
· Discharge planning experience.
· Substance Use Experience is preferred
About the Company
RepuCare, a certified Woman Owned Business (WBE) is the driving force behind innovative workforce solutions. We are partnered with a large managed care provider in search of a Nurse Case Manager, Obstetrics for their team. The Obstetrics Case Manager RN is a very important role, as it supports a large state run program in managed care.
**This position requires travel and in-person meetings, including Teams/Zoom. While the majority of the position is working remotely, there is a travel requirement. Additionally, there is a COVID/FLU vaccine requirement, as there are in-person visits**