RN Case Manager
2 days ago
RN Case Manager - Care Ally - Carol Stream
- Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed
- Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
- Employer provided life and disability insurance.
- $5,250 Tuition Reimbursement per year.
- Immediate 401(k) match.
- 40 hours paid volunteer time off.
- A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
- Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
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.
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).
- Associate's degree in nursing required; Bachelor's degree in nursing preferred.
- 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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