Behavioral Health RN Case Manager

Join our dedicated team as a Behavioral Health RN Case Manager, where you will play a vital role in delivering integrated case management and disease management services. Your expertise in clinical judgment and independent analysis will empower you to collaborate with patients, clinical nurses, and physicians to develop and implement comprehensive care plans tailored to individual needs. As a Case Manager, you will: Conduct accurate and thorough assessments to determine members' needs. Utilize your extensive knowledge of established medical policies and clinical guidelines to enhance each case's effectiveness. Manage complex cases while promoting high-quality and cost-effective healthcare services based on medical necessity. Provide guidance to our provider network and facilitate effective discharge planning in collaboration with healthcare professionals. Coordinate care for lower levels, including Skilled Nursing Facilities, Residential Treatment Centers, Home Health, and Rehabilitation Services. Educate patients on managing chronic conditions such as Diabetes, Heart Failure, and COPD. Make referrals to relevant departments for quality management and case oversight. Essential Skills and Qualifications: Proficiency in PC-based software programs, especially Word and Excel. Strong clinical documentation and independent problem-solving skills. Exceptional communication and negotiation skills, both verbal and written. Understanding of NCQA standards and federal regulatory requirements. Knowledge of coordination of care, prior authorization processes, and criteria for level of care. Ability to demonstrate judgment and critical thinking to ensure quality care delivery. Excellence in case preparation and project management, with proven leadership abilities. If you are passionate about making a difference in patients' lives and have the skills to excel in a collaborative environment, we invite you to apply for this rewarding position.