*Nurse Case Manager II - Maryland

Annapolis, MD 21401

Posted: 07/08/2024 Job Number: z5G7h3l6a1kMvyS65NP3c4FLbkuA3Scb2Mbjxr9mH0k= Pay Rate: 44-44 Hourly USD

Job Description


Here are the job details for your review:  

Job Title: Nurse Case Manager II - Maryland

Job Location- Field Annapolis MD 21401

Duration: 6+ Months Contract (Potential for extension)

Pay Rate:$44.44 HR on W2         

Shift – M-F 8 AM-5 PM

Client Name: CVS Health/Aetna

 

Service Area: Howard Co, Carroll Co., Baltimore Co, Frederick Co, Montgomery Co, Prince George's Co, Ann  Arandel Co.

Local travel: 50-75% - Miles will be Paid

 

Description

·         Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

·         Develops a proactive course of action to address issues presented to enhance the short and long- term outcomes as well as opportunities to enhance a member’s overall wellness through integration.

·         Services strategies policies and programs are network management and clinical coverage policies.

·         Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

·         Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

·         Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

·         Reviews prior claims to address potential impact on current case management and eligibility.

·         Assessments include the member’s level of work capacity and related restrictions/limitations.

·         Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

·         Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.

·         Utilizes case management processes in compliance with regulatory and company policies and procedures.

·         Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

 

Experience

Managed care experience, previous work at home and field based face to face visit experience

Prior case management experience

Medicaid experience.

Crisis intervention skills

Certified Case Manager (CCM) certification

Case management experience in an integrated model

Case management and discharge planning experience

Familiarity with Quick Base

BSN degree preferred

 

Education

RN with current unrestricted state licensure.

Case Management Certification?CCM? preferred?
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