Nurse Case Manager

The Nurse Care Manager (CM) Manager is responsible, as part of the care team, for the overall patient Care Management process. The CM provides oversight, guidance and support for the member care plan as developed through clinician, CM and allied clinical support evaluation and physical risk assessment.

The CM uses nursing assessment and evaluation skills to help guide treatment and care decisions of the team and also identifies services and vendors for needed care while navigating patient benefit plans. The CM works collaboratively with a multidisciplinary team of PCP, specialists, Behavioral Health clinicians, midlevel practitioners, pharmacist, nutritionist and Social Worker and the member, family and/or caregiver as they provide supportive care to enrolled members.

The CM ensures that medical services are managed in the most effective and appropriate health care setting according to the member’s medical condition. The CM is responsible for developing and implementing a plan of care appropriate to the member’s clinical condition and psycho/social needs to maximize his/her level of functioning and establishing and maintaining communications with the responsible party of the member.