HMC Nurse Care Mgr I/II - (Complex Care) Atlanta - (US-GA-Atlanta - 39901)

Minimum Education: Tech School
Job Type: Full Time
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HMC Nurses Change Lives!

Come grow with us and help us build some healthier lives, including yours. Join the HMC family where employee well being and satisfaction is the core of our vision. Experience the refreshing difference of a HMC career.

HMC (Health Management Corporation) is a wholly owned subsidiary of WellPoint, Inc. The WellPoint family of companies provides health care benefits t
o approximately 34 million people and is the largest publicly traded commercial h
ealth benefits company in the United States.

This position is a staff level position as a RN within a Call Center environment

Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs. Primary duties may include, but are not limited to: Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Works with member to assess knowledge of condition, educates where necessary with goal of improving health and health behavior. Implements referrals as appropriate. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Presents cases for discussion at Grand Rounds/Care Conferences. May require the development of a focused skill set including comprehensive knowledge of specific disease processes or traumatic injuries and may function as preceptor for new care management staff. May participate in department audit activities.

Skills:
As business needs may require, this position may require additional state licenseseither now or in the future. Inability or unwillingness to obtain these required licenses may result in either re-assignment (if available) or termination. Obtaining required licenses is a requirement for continued employment. Requires an unrestricted RN licensure in applicable state(s) and 3 years clinical experience; or Certification as a case manager; or any combination of education and experience, which would provide an equivalent background. Bachelors (or higher) degree in nursing, or certification as a case manager, knowledge of health insurance/benefits and 3 years experience in disease management, health education or home health/discharge planning preferred.

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