RN Case Manager
4 weeks ago
We are seeking a skilled RN Case Manager to provide Disease Management services to TRICARE beneficiaries. As a key member of our team, you will collaborate with healthcare providers and patients to assess, plan, implement, and evaluate health and psychosocial needs.
Key Responsibilities- Assess beneficiaries to identify medical, physical, and psychosocial needs to support their overall goals of care.
- Ensure and evaluate clinical appropriateness of care plans by incorporating assessment findings against evidence-based guidelines, clinical reasoning, and clinical practice guidelines.
- Provide education and coaching specific to the beneficiary needs to prevent exacerbations or worsening chronic conditions.
- Manage activities necessary to ensure appropriate utilization and access to resources while maintaining optimal standards of care.
- Review, identify, and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.
- Participate in the development of measurable outcomes, ensure measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
- Facilitate transfer of beneficiaries between different regions and within regions by collaborating with the military liaison to support the transition with minimal disruption.
- Current, unrestricted RN licensure to independently work within the scope of practice within the state of residence.
- U.S. citizenship.
- The ability to obtain multi-state licensure; if a resident in a NCL state.
- Minimum of three years clinical experience.
- Experience in case management, care coordination, or discharge planning in an acute, ambulatory, or specialty disease management program settings in a healthcare system or managed care organization (MCO).
- Disease Management experience with a managed care organization (MCO).
- Bachelors degree or other related health field.
- Knowledge of government healthcare programs, TRICARE, and Medicare/Medicaid.
Competencies
- Technical Skills: Knowledge of TRICARE programs and benefits, managed care concepts, and URAC DM program standards; case management interventions, crisis intervention strategies, collaboration skills, legal and regulatory requirements, and HIPAA privacy regulations.
- Team building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
- Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
- Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources, detail oriented.
- Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
- Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
- Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.
- Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
- Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, Intranet, the Internet, and department software.
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