Clinical - Care Manager I (RN)

Location: Remote for Cuyahoga county Ohio, NE Region OH- Member Facing
SHIFT: 8-5 PM, No OT Required

Job Description: Description - Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care

" Develop, assess and adjust, as necessary, the care plan and promote desired outcome
" Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
" Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
" Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
" Provide patient and provider education
" Facilitate member access to community based services
" Monitor referrals made to community based organizations, medical care and other services to support the members overall care management plan
" Actively participate in integrated team care management rounds
" Identify related risk management quality concerns and report these scenarios to the appropriate resources
" Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Qualifications - External

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor s degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.

Licenses/Certifications: Current state s RN license.
F2F, Home visits required (2 times a week).

Walk me through the day to day responsibilities of this the role and a description of the project:

• assessments, visits, obtaining home care, DME , work with delegated vendor, must be proficient in computer work

Describe the performance expectations/metrics for this individual and their team:

• They must meet productivity of 200 notes a month and must see members face to face

Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1. Care Manage Exp 1. 2. Microsoft Office/Technology 2. 3. 3. Education Requirement: RN is Required Education Preferred:

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