Job Description Summary

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Manage quality, cost-effective care using selective benefits and alternative services best suited for the member. Collaborate in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members’ health needs.

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How will you make an impact & Requirements

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CareMore Care Manager

Job Description Responsibilities:

• Manage quality, cost-effective care using selective benefits and alternative services best suited for the member.

• Collaborate in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet members’ health needs.

• Support members or their representatives regarding care, care transitions, and changes in health status.

• Implement a comprehensive clinical case management plan for each patient.

• Obtain input from providers, patients, and families as appropriate, and evaluate and revise the plan as needed.

• Analyze patient variances from the plan and initiate appropriate steps to resolve variances.

• Perform admission and concurrent stay reviews on hospitalized patients.

• Develop and implement discharge planning for patients in conjunction with hospital-based case managers.

• Perform telephonic, fax, and/or on-site reviews with skilled nursing facilities, home health agencies, or other contracted service agencies to determine the need for continued care.

Qualifications:

• High school diploma or equivalent.

• Minimum of 2 years of experience; or any combination of education and experience which would provide an equivalent background.

• Current unrestricted RN license in applicable state(s) required.

• For Carelon Health business units, satisfactory completion of a Tuberculosis test is a requirement for this position.

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