PURPOSE

Case Managers are responsible for providing Case Management services to plan members to promote cost effective, high quality care.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Case Managers shall be responsible for all phases of Care Management, but shall be primarily focused on:

A. Assessment: Once appropriate cases have been identified Case Managers shall be responsible for contacting patients to explain Case Management and the associated process. Case Managers shall determine individual needs based on factors such as Medical Condition, Psychological Condition, work history and situation, any payer complications, external resources. Additional pertinent factors shall also be considered.

B. Plan Development: Once assessment has been completed the Case Manager shall develop a plan that coordinates the appropriate treatment considering the facts of the assessment. The Case Manager shall provide the plan member with data to make informed decisions, and should suggest alternative forms of treatment or contingencies where possible. The Case Manager will facilitate communication between the member and the care team, and obtain approval from all parties whenever possible (member, family, providers, and payers). The plan should consider both maximize benefit to the member, while keeping cost as minimal as possible.

C. Implementation: Once the plan has been approved by the member, the Case Manager should act as liaison between all parties. The primary goal is providing excellent care based on the decided upon plan to ensure that the desired outcome is reached.

D. Evaluation of the Plan: Constant re-evaluation is required to ensure the plan is performing as designed, and to the expectations of all parties. The Case Manager shall continuously re-assess the plan and suggest changes where necessary.

Case Managers shall also assist in Identification and Selection, and Termination of the Case Management process as able in cooperation with Claim Analysts.

Case Managers are also responsible for detailed note taking. The who, where, what, when, and why should be documented for the care plan, and all decisions pertaining to the care plan. Strong written and oral communication skills are requisite for the position.

Skills

  • Excellent communication, written, telephonic and personal skills
  • Ability to manage and follow through consistently and accurately
  • Attention to detail
  • Completion of all responsibilities in a timely manner
  • Independent thinking
  • Strong Organization Skills

Qualifications

  • Bachelor’s Degree strongly preferred
  • Minimum 5 Years Clinical Nursing Experience
  • UM or Case Management Experience Preferred
  • Current Nursing License – Tennessee, Kentucky, Illinois, Indiana, Florida preferred
  • Team skills
  • Strong communication skills

Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Equal Employment Opportunity Policy Statement: Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

 

 

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