RN Field Case Manager - Telephonic WA State ONLY

Assess the health status of members within licensure scope and establish goals to meet identified health care needs. Plan, implement, and evaluate responses to the plan of care while working collaboratively with the multidisciplinary team to address medical, functional, and social barriers. Bridge the gap between mental and physical health by consulting with primary care physicians and specialists as appropriate. Assess patient needs for community resources, facilitate transitions between health care settings, and provide counseling and education regarding health maintenance and disease prevention. Completely and accurately document all interactions in the patient's electronic medical record and verify patient understanding of the condition and follow-up recommendations. Actively participate in organizational quality initiatives and multidisciplinary team meetings to optimize care delivery efficiency. Maintain essential credentials including licensure, certification, and CEUs.