RN Care Manager
3 weeks ago
The RN Care Manager serves as the key point of contact and coordinator of care to members experiencing an acute, catastrophic, or costly health care event.
Key Responsibilities- Performs within licensed scope of nursing practice and under the direction of the Sr. Director, Clinical Services
- Identifies, screens, and enrolls members meeting criteria into Care Management Services
- Educates members and providers (as appropriate) regarding the Medi-Share provisions and processes
- Confirms member's condition and plan of care are eligible for sharing based on Medi-Share and FDA/CMS approved evidence-based clinical management guidelines; suggests resources for those conditions/plan of care not eligible for sharing
- Identifies, educates, and facilitates member participation in appropriate member stewardship including, but not limited to patient assistance programs for medication, laboratory, and genetic testing
- Provides disease/condition specific clinical education to include multimedia resources, if available
- Identifies opportunities for and facilitates transitional care
- Partners with organizational resources to facilitate effective and cost-efficient outcomes for members
- Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
- Documents case work, all telephone conversations, correspondence, and tasks completely and accurately in appropriate IT systems
- Maintains and independently manages assigned caseload and departmental workflows within agreed service levels
- Presents accurate, complete, and concise case information to Sr. Director, Clinical Services within agreed upon service levels
- Completes medically related special projects independently as assigned with minimal supervision
- Attends all required departmental and organizational meetings
- Prays with members and providers as appropriate
- Contributes to the exercise and expression of the Ministry's Christian beliefs
- Registered nurse with a current unrestricted multi-state compact license or willingness to pursue
- Bachelor of Science in Nursing (strongly preferred) or health-related field (required)
- Cardiovascular, Medical/surgical, orthopedic, pediatrics, and/or transplant clinical experience required
- 3+ years nursing experience required; acute and catastrophic care highly preferred
- 2+ years of case management and/or utilization management and discharge planning experience
- Have or willing to obtain a certification in either case management or managed care nursing within two years
We offer a comprehensive benefits package, including annual incentive pay, 100% paid Medical for employees/99% for family, generous employer Health Savings Account (HSA) contributions, and more.
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