The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation, and advocacy to meet an individual’s health needs through communication and available resources to promote optimal, cost-effective outcomes. Responsibilities include conducting comprehensive clinical assessments, developing and implementing case management plans, and providing coaching and education to empower members for independent health choices.

This role involves working intensely as a telephonic case manager with patients and their care team, applying clinical judgment and guidelines to ensure appropriate administration of benefits and address complex health indicators. The Case Manager must utilize a holistic approach, consult with clinical colleagues, and actively reach out to members to guide their care while performing medical necessity reviews.

Registered Nurse advising on outpatient clinical documentation

This role involves the concurrent review of inpatient medical records to identify opportunities for improving physician documentation quality through interaction with physicians and the healthcare team. The primary goal is to achieve a complete medical record that supports complete, accurate, and timely coding.