The Nurse Care Manager works cooperatively with members of the health care team as well as the plan member to maximize outcomes and decrease utilization. This position also participates in preventive health initiatives aimed at improving the long-term health and wellness of health plan members.



RESPONSIBILITIES:



Develop and maintain collaborative and proactive relationships with members and Provider partners, to maximize member health care outcomes.

Evaluate the appropriateness, necessity, and quality of health care provided to members. Compliance with regulatory time restrictions. Utilization programs include: pre-authorization for services, concurrent hospital stay reviews / planning, and Retro-Review / evaluation program participation.

Care-coordination activities

Case Management for members with high risk / high utilization indications, which includes monitoring the individuals treatment assessing the treatment plan to achieve the best outcome and the most cost effective use of health care services for the member.

Other duties as assigned.
REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

This is an office based position, and requires sitting at a desk for extended periods, using multiple computer screens, multi tasking, working collaboratively with other staff and disciplinary teams.



· Excellent verbal / written communication skills.

· Strong prioritization, organizational and time management skills.

· Sound judgment and a thorough knowledge of medical practices and terminology are essential.

· Demonstrate a close attention to detail and ability to multitask effectively.

· Must be a team player able to create and preserve strong/effective work relationships.

· Must have intermediate to advanced skills in MS Office and MS Office products, including Word and Excel. Must be comfortable using multiple computer screens to accomplish tasks.

· Must be flexible and open to new challenges and shifting priorities.



PREFERRED QUALIFICATIONS:



1. Minimum of 2 years Utilization Management / Case Management

2. Knowledge of Interqual utilization criteria.

3. Experience using IDX software.



EDUCATION AND EXPERIENCE:



1. Washington State RN license

2. Broad-based clinical background

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