RN Field Case Manager - Telephonic WA State ONLY

Assess the health status of members and establish goals to meet identified health care needs within the scope of licensure. Plan, implement, and evaluate responses to the plan of care while working collaboratively with the multidisciplinary team to address medical, functional, and social barriers. Consult with the patient's PCP, specialists, or other health care professionals as appropriate and assess patient needs for community resources to make referrals. Facilitate the patient's transition within and between health care settings in collaboration with the primary care physician. Complete and accurately document in the patient's electronic medical record and provide counseling and education regarding health maintenance and disease prevention. Actively participate in organizational quality initiatives and collaborative multidisciplinary team meetings to optimize clinical integration. Maintain credentials essential for practice, including licensure, certification, and CEUs.