RN Care Manager

RN Care ManagerMargate, FL, USA Req 525 Monday, August 1, 2022Centers Plan for Healthy Living''s goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.Primary Responsibilities: Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needsDevelops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the members itiates utilization review for preauthorization and post service reviewsUtilizes knowledge of community resources and the members benefit structureInteracts with providers and facilities in a professional, respectful manner Recognizes quality of care issues and escalates the issues appropriatelyAssists members with the coordination of services from various settings as appropriateappropriateComplies with all CCSs standards for documentationParticipates in case roundsParticipates in on call coverageParticipates in other meetings as requestedParticipates in quality improvement initiativesOther duties as assignedRequired:Active and unrestricted NYS RN licenseStrong written and verbal communication skillsPreferred:Bachelor of Science in NursingCCM certificationKnowledge of Milliman or InterQual criteriaExperience providing care in the home settingExperience working within a managed care environment Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.Other detailsPay Type Salary Apply NowMargate, FL, USA

Created: 2025-09-06