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 needs Develops, 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 reviews Utilizes knowledge of community resources and the member’s benefit structure Interacts with providers and facilities in a professional, respectful manner Recognizes quality of care issues and escalates the issues appropriately Assists members with the coordination of services from various settings as appropriate appropriate Complies with all CCSs standards for documentation Participates in case rounds Participates in on call coverage Participates in other meetings as requested Participates in quality improvement initiatives Other duties as assigned Required:Strong 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 offer:Hybrid schedule (for employees who qualify)