Care Solutions is seeking RN Care Manager Join the excitement in support of our MLTC and Medicare Advantage Plan businesses!Centers Care Solutions (CCS), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CCS is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community The Care Manager works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Through interventions such as complex case management and utilization management, the care manager will ensure coordination of health care services, member education, and preventative interventions. PRIMARY RESPONSIBILITIES: Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needsDevelops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member’s care.Initiates utilization review for preauthorization and post service reviewsUtilizes knowledge of community resources and the member’s benefit structureInteracts with providers and facilities in a professional, respectful manner Recognizes quality of care issues and escalates the issues appropriatelyAssists members with the coordination of services from various settings as appropriateComplies with all CCSs standards for documentationParticipates in case roundsParticipates in on call coverageParticipates in other meetings as requestedParticipates in quality improvement initiativesOther duties as assignedRequired: Active and unrestricted RN licenseStrong written and verbal communication skillsPreferred: Bachelor of Science in NursingCCM certificationKnowledge of Milliman or InterQual criteriaExperience providing care in the home settingExperience working within a managed care environmentWe OfferOffice Based PositionsCompetitive WagesHealth BenefitsDental InsuranceVision InsuranceGenerous Paid Time OffVoluntary Employee Benefit Programs401KLife InsuranceReferral Award ProgramPaid Training