Nurse Case Manager - (Helena, MT)

Coordinate all aspects of the care of individual members. Ensure proper utilization of services and resources. Review of prior authorization requests for appropriateness of care within established evidence base criteria sets. Provide assistance within, between, and outside of facilities. Facilitate outstanding member care using fiscally responsible strategies. Work closely with physicians, nurses, social workers and a wide spectrum of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member---s specific health plan benefits and the additional medical, community, or financial resources available Collect and assess member info pertinent to member---s history, condition, and functional abilities in order to develop a comprehensive, individualized care plan that promotes wellness, appropriate utilization, and cost-effective care and services.