RN Case Manager

Manage daily case management strategies for Medicare Advantage members by conducting in-person and telephonic patient visits to ensure proper nursing care. Interview physicians to correct errors, investigate questionable claims, and coordinate with the health care team to assess, plan, implement, and evaluate patient care plans. Complete health risk assessments, initiate and revise care plans, and coordinate outpatient discharge planning based on clinical circumstances and benefit coverage. Respond to day-to-day care coordination problems, provide patient and staff education, and participate in audits and improvement projects involving data analysis and report generation. Maintain a case load and apply medical management criteria while collaborating with interdisciplinary teams.