RN - Care Manager No nights or weekends!

Responsible for assessment of member needs, assessment of community and facility resources, and development of medical management plans to meet those needs. Medical management, which includes medical, behavioral health, pretreatment authorization, concurrent review, retrospective review and member care management, is performed in coordination with healthcare providers and members, and may be performed telephonically or onsite. Medical management may include coordination of inpatient or outpatient services across all continuums of care. This position reports directly to the Director of Episodic or Member Care Management and is supported by the Vice President, Medical Director, a physician who has a non-restricted license to practice medicine in the United States.

Primary Responsibilities Assesses member health status through the collection of information using the pretreatment authorization, concurrent and retrospective review processes with the healthcare provider interactions to identify member needs. The care manager will develop a comprehensive plan of care that will address those needs. Stratifies member into appropriate medical management program based on those needs. Performs medical management activities using nationally recognized and accepted clinical criteria and/or Great-West Life national medical policy to review member progress and identify treatment plan goals or need for revision in the goals. Develops medical management interventions to meet member needs through coordination of care plans and communication with physician, ancillary providers, discharge planners, other healthcare providers, the member, and the employer as appropriate, that will lead to the accomplishment of goals. The care manager will ensure that the services are delivered in the most cost-effective manner through the redirection to network providers or negotiation of rates for services. Coordinates facility and community resources, modifying as necessary, to ensure that the member's needs are met based on the goals set forth and that appropriate services are being delivered. Provides for ongoing monitoring and evaluation of member needs, at appropriate intervals, according to medical management criteria to ensure the care management plan's effectiveness toward meeting the member's goals throughout the continuum of care. Maintains accurate and timely documentation of all medical management activities in accordance with regulatory requirements. Maintains communication with Medical Management Director as well as the Medical Director to ensure appropriate treatment plans are in place. Actively participates in maintaining expertise in field by attending continuing education activities.
Background and Qualifications RN required, BSN preferred. Must have 5+ years experience as an RN including acute care experience (preferably in a Medical/Surgical setting). Experience in Case Management or Utilization Review preferred. Certification in Case Management / Care Management preferred. Intermediate skills in MS Windows and MS Word required. Typing of 45+ WPM preferred. Ability to multi-task with strong organizational skills required. Knowledge of the insurance industry a plus.

You'll find good people at Great-West. Our good people make us a good company to do business with and a great place to grow your career!

Great-West Healthcare, a division of Great-West Life & Annuity Insurance Company, is a national employee benefits provider with expertise in self-funding and health care management solutions. With sales offices across the United States, the division provides more than 5,000 companies with a suite of employee benefit products and services including traditional and consumer-driven health plans; COBRA, HIPAA, and flexible spending account administration; dental and vision plans; life insurance benefits, and short-term and long-term disability coverage. It operates a nationwide health care network that includes approximately 4,250 hospitals and 547,000 providers and provides coverage to 2 million people. Offering creative benefits solutions that engage employees and help business manage costs, Great-West Healthcare pioneers New Ideas from the Frontier of Health CareSM.

For more information, please visit us at www.greatwest.com. We are an equal opportunity employer dedicated to workforce diversity. We are committed to providing a drug-free workplace.