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Job Details
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Job Information:
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Job title
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Case Manager -
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Company
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AppleOne
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Wage
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between $0.00 - $0.00 Annually
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Location
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United States, Arizona, Phoenix
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Employment type
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Full Time
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Education
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Not Specified
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Year Experience
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4 - 5 Years of Practical Experience
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Travel
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Not Specified
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Published on
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9/21/2011
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Description
POSITION GOAL:
Under the direction of the Case Management Manager, the primary purpose of this position is to assess, plan, implement, coordinate, monitor, and evaluate options and services to meet complex health needs of individuals and/or populations for inpatients and/or outpatients, which promote appropriate, timely, clinically effective, and cost-efficient patient care.
QUALIFICATIONS:
Required for successful performance in this position is a current, unrestricted Arizona State nursing license, at least three years experience in an acute care environment and two years experience in utilization or case management. Required skills and abilities include coordinating member care with the members provider, social services, pharmacist and other members of the health care team. Working experience with computers, data entry, Word and Excel are required, as is excellent written and verbal communication skills. BSN and knowledge of and experience with AHCCCS is preferred. Certification in case management is also preferred.
DUTIES AND RESPONSIBILITIES:
Using a collaborative team approach, assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet complex health needs of individuals and/or populations, inpatient and/or outpatient, which promote appropriate, timely, clinically effective, and cost-efficient patient care.
Responsible for insuring through facilitation, negotiation, procurement, advocacy, communication, and empowerment, the quality care, appropriate costing, and involvement necessary for the achievement of mutually developed treatment goals.
Incorporates principles of managed care and utilization management in providing appropriate, quality, and cost effective care across the continuum.
Performs and documents timely, comprehensive, initial and follow-up assessments of complex patients (high risk, high cost, high volume, problem prone).
Consistently communicates with the PCP and interdisciplinary team to facilitate the timely achievement of desired member outcomes, including documentation in the medical record and maintenance of a case management record.
Provides and documents member/family provider teaching education/materials to promote self-care capabilities.
Evaluates data reflective of the members status and interprets the information to identify each members requirements relative to his/her age specific needs.
Performs concurrent review or prior authorization (utilizing Milliman Care Guidelines) on assigned members as indicated to include review of medical records, discussions with attending physicians, social workers, and any appropriate ancillary medical personnel.
Meets internal and external customer service expectations regarding duties and professionalism.
Performs other responsibilities as assigned that are consistent with the goals and qualifications of this position, which may include on-call responsibilities and coverage for other Case Managers.
This position performs all related duties in a manner that is consistent with and in support of the Ultimate Care Model and the organizations mission, vision, values and goals.
OTHER REQUIREMENTS:
Employee Health: All positions require that employees remain in compliance with Employee Health policy.
Compliance Requirements: Participates in all mandatory compliance-training programs, seeks guidance for compliance-related concerns and adheres to all applicable laws, regulations and
We are an equal employment opportunity employer.df-hm
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Experience/Skills
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This job has expired.
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