About Job

Job Description Summary

Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.

How will you make an impact & Requirements

With nearly 30 years of experience in providing advanced primary care, Carelon APC delivers exceptional patient experiences. Compassionate clinicians take the time to understand each patient's unique health needs while also removing barriers to access. Patients trust us to receive the right personalized care where and when they need it - in our care centers, at home or virtually - to improve their health outcomes and quality of life.

Performs duties telephonically or on-site such as at hospitals for discharge planning.

Primary duties may include, but are not limited to:

Ensures member access to services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.

Requirements:

Requires BA/BS in a health related field
Minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in applicable state(s) required.
Multi-state licensure is required if this individual is providing services in multiple states.
Certification as a Case Manager is preferred.

Compensation: $38.88/hr. - $48.60/hr. & bonus eligible