Care Management Nurse
· Responsible for handling cases, while interfacing with key stakeholders (internal/external) to ensure optimal care management.
· Collaborates in a patient care process to assess, plan, facilitates, coordinate, monitor and evaluate options and services that meets member’s needs.
· Implements a comprehensive clinical ca
se management plan for each patient.
· Obtain input from providers, patients and family as appropriate, and evaluates and revises the plan as needed.
· Analyze patient variances from the plan and initiates the appropriateness steps to resolve discrepancies.
· Assess and refer patients for special program/services when appropriate.
· Support member in their representative regarding care, care transition and changes in health status.
· Develops and implements transition of care for patients in conjunction with hospital-based care managers.
· Performs telephone, email, fax and/or face to face interactions to determine needs for continued care.
· Communicate patient benefits and responsibilities timely and accurately.
· Provide coordination in caseload to ensure all elements and tasks are completed timely and ensure cases move through the process as required.
· Responsible providing communications to patient’s healthcare providers other representatives and external stakeholders.
· Perform quality checks and report trends to leadership and during interdisciplinary care team meetings accordingly.
· Documents the progress of the condition of the member and all the arrangements made using the electronic application within the work plan and the electronic health record, according to the policies and procedures established.
· Responsible for good housekeeping techniques adhering to quality and production standards while complying with all applicable company, state and federal standards.
Current/ valid license in Puerto Rico Register Nurse, in Good Standing or without restrictions.
Member of College of Nursing Professional of Puerto Rico.