RN Case Manager / 802

Job Status: Full Time, Employee Job Category: Medical/Health Career Level: Experienced (Non-Manager) Reference Code: 802 Visit us on the web http://apshealthcare.com/ APS was founded as a behavioral healthcare company and has evolved into a specialty healthcare company that offers customized, integrated healthcare solutions across two major product lines: care management and behavioral healthcare services. The company has capitalized on its experience in behavior change to create physical and mental healthcare programs that are industry renowned. The use of an integrated approach to healthcare for the mind and body has allowed APS to be more effective in improving the quality and effectiveness of care. Today, APS is a pioneer in providing health and disease management services while retaining its position as one of the leading behavioral healthcare organizations in the United States. In fact, APS is the only specialty healthcare company with extensive experience in health management, behavioral healthcare, employee assistance programs (EAP), informatics and quality review/oversight programs. RN Case Manager / 802 Position Description:External Job Description: Summary: Provides telephonic case management with high acuity members.Revised: 5/30/08Responsibilities:• Responsible for carrying out telephonic Case Management activities on all Medicaid members in the program with the highest acuity level• Activities include assessment, planning, implementing, coordinating, monitoring and evaluating the services and resources necessary to respond to an individual member’s health needs. * Serves as member's advocate and maintain client's safety.* Adheres to all applicable legal and regulatory standards.* Activities and interventions performed across case management practice and processes maintain member's privacy and confidentiality by adhering to HIPAA regulations. This includes client record confidentially.* Adheres to ethical standards, as well as accreditation standards.• Provides members/family education by interacting with members/family, practitioners, social workers and medical office staff to obtain established goals and outcomes for members.• Perform Care Plan development and follow-up in accordance with established goals.• Monitor for quality of care and outcome improvement in accordance with clinical indicators as per contractual obligations.• Communicates with providers in the community regarding the consumer’s treatment needs and develops appropriate care plans for specialized needs; and• Others duties as assignedEducationalRequirements:• Registered Nurse with active Georgia license• CCM Preferred• Ability to sit for CCM within 15 months of hireMinimumQualifications:• Minimum of 3-5 years experience in related public sector medical services including experience with quality improvement, medical record reviews, disease management and/or primary care case management;• Three (3) years of current clinical nursing experience and must possess clinical experience in an area such as medical, surgical, critical care, home health or skilled nursing.• Three (3) years of experience in case management, discharge planning, and/or utilization review), and/ or quality improvement• Experience with chronic illness and disease states targeted by DCH strongly preferred;• Strong verbal and written communication skills• Experience with clinical care computer systems, data entry and call center environment preferred;• Customer service focus; and• Ability to utilize critical thinking and problem solve in a non-threatening manner