About Job

Job Description Summary

Responsible for managing quality, cost effective care using selective benefits and alternative services best suited for the member.

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.

Primary duties may include, but are not limited to:

Collaborates in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet member's health needs.
Supports member or their representative in regard to care, care transitions, and changes in health status.
Implements a comprehensive clinical case management plan for each patient.
Obtains input from providers, patient, and family as appropriate, and evaluates and revises the plan as needed.
Analyzes patient variances from the plan and initiates the appropriate steps to resolve variances.
Performs admission and concurrent stay reviews on hospitalized patients.
Develops and implements discharge planning for patients in conjunction with hospital based case managers.
Performs telephonic, fax and/or on-site reviews with skilled nursing facilities, home health agencies or other contracted service agencies to determine need for continued care.

Requirements:

Requires a LVN, LPN or RN
Minimum of 2 years of experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted LVN, LPN, or RN license in applicable state(s) required.
Satisfactory completion of a Tuberculosis test is a requirement for this position.

Compensation: $40.57/hr. - $50.71/hr. & bonus eligible