Case/Disease Management Nurse Navigator

Must have 5 years experience and have an active Ohio or WV license. Will be responsible for assessing moderate to high risk patients for case management/disease management intervention and coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member, their benefit plan, and community resources. Directs intervention with moderate to high risk members, and provides education, support and oversight to other team members managing low risk members. Interfaces with providers of medical/behavioral services and equipment to facilitate effective communication, referrals, development of discharge planning and care plan development. Initiates contact with patient/family, physician, and health care providers/suppliers to discuss the care plan. Monitors, evaluates, extends, revises or closes treatment plans as appropriate. Evaluates cases for quality of care. Communicates case management plans and decisions. Understands and follows policies and procedures and performs care coordination duties and documentation in a timely manner. Handles moderate to high risk and/or complex cases. Initiates and leads the multi-disciplinary care planning process. Complete job description available on company website.