RN Case Manager

3 days ago

Downers Grove, United States Duly Health and Care Full time
Overview

RN Case Manager - Care Ally - Naperville
  • Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed.
  • Location: Rolling Ridge - 2940 Rollingridge Drive, Naperville, IL.
Holistic benefits designed to help our team members flourish in all aspects of their lives, including:
  • Comprehensive medical and prescription drug benefits that include medical coverage at 100% (after deductible) when utilizing a Duly provider.
  • $5,250 Tuition Reimbursement per year.
  • 40 hours paid volunteer time off.
  • A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact
  • 12 Weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
  • 401(k) Match
  • Profit-sharing program
The RN Case Manager - Care Ally works in collaboration with physicians, patients and families to promote quality outcomes for patients with complex medical needs. The Case Manager is responsible for increasing efficient utilization of health care services; identifying chronic or catastrophic cases through the case management process and initiating intensive case management according to program guidelines. The Case Manager is responsible for managing patients in all health care settings to assure the appropriate level-of-care is provided, to prevent inpatient re-admissions and ensure that the patients' medical, environmental and psychosocial needs are met over the continuum of care. The Nurse Case Manager acts as an advocate through the coordination and communication with the health care team and family regarding care planning and implementation of recovery goals. In addition, the case manager will assess and coordinate resources available to patients and maximize the use of health care benefits.

Responsibilities
  • Analyze data collected from the predictive modeling tools to identify eligible patients for the Case Management Program.
  • Enroll and manage a case load of patients with complex medical needs, completing case management attestations and initial assessments in accordance with health plan requirements.
  • Develop individualized case management plans with prioritized goals and appropriate interventions in compliance with the risk stratification level requirements. In addition, complete all documentation, member communications, and case closures per policies and procedures.
  • Proficient in knowledge of current Case Management Standards
  • Coordinate Health Care Services with appropriate physicians and health care providers.
  • Manage and provide a comprehensive summary and log of all active Case Management Cases as required by the UM/QA Committee and/or Health Plan.
  • Act as a resource for Utilization Management Staff, physicians, office staff and Patients.
  • Assist with the evaluation and amendment of Case Management Policy and Procedures
  • Attend continuing education sessions and training relating to your job functions as required.
  • Perform additional duties/tasks as assigned.
Qualifications

LICENSURE/CERTIFICATION:
  • Must be an active Registered Nurse License in the State of Illinois in good standing.
  • Certification in Case Management, preferred.
  • Current CPR certification must be maintained (BLS).
EDUCATION:
  • Associate's degree in nursing required; Bachelor's degree in nursing preferred.
EXPERIENCE:
  • 2-4 years of experience working within the primary care or hospital setting as a Registered Nurse.
  • Previous experience working within case management preferred.

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