Case Manager

Description:

Care Managers perform integrated case management (CM) and disease management (UM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. Care Managers determine, develop and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. Care Managers apply detailed knowledge of established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case. Responsibilities:

• Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member’s needs.
• Applies detailed knowledge of FEP PPO established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.
• Works with complex cases, promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits.
• Provides guidance to the provider network via telephone triage.
• Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care via phone/ computer work.
• Makes referrals to Quality Management, Catastrophic Case Management and Appeals and Grievance Department via computer and virtual meetings.
  

Skills:

Acute care, acute, nurse, clinical, healthcare, Case management, Utilization management, Utilization review, Insurance

Top Skills Details:

Acute care, acute, nurse, clinical, healthcare,Case management

Additional Skills & Qualifications:

• Bachelor’ s of Science in Nursing or advanced degree preferred.
• Active Oklahoma RN license required.
• Must have specialty training in one of the following specialized areas: case management, .
• 5 years experience in case management, utilization Review
  

Experience Level:

Intermediate Level

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people