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Care Manager RN
2 months ago
Join Superior HealthPlan as a Care Manager RN and play a vital role in transforming the health of our communities. As a member of our team, you will have the opportunity to make a meaningful impact on the lives of our 28 million members.
About the Role:
We are seeking a skilled and compassionate Care Manager RN to join our team. In this role, you will be responsible for assessing and coordinating medical and supporting services for complex/high acuity populations. Your primary goal will be to promote quality, cost-effective care and develop personalized care plans for our long-term care members.
Key Responsibilities:
- Evaluate the service needs of our most complex or high-risk members and recommend a plan for the best outcome.
- Develop and continuously assess ongoing long-term care plans and collaborate with the care management team to identify providers, specialists, and community resources needed to address member needs.
- Coordinate and manage between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
- Monitor care plans and member status, change in condition, and progress towards care plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan as necessary to meet the member's goals/needs.
- Monitor member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable.
- Review member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
- Review referrals information and intake assessments to develop appropriate care plans.
- Collaborate with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed.
- Collect, document, and maintain all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines.
- Provide and/or facilitate education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
- Act as liaison and member advocate between the member/family, physician, and facilities/agencies.
- Educate on and coordinate community resources. Provide coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living).
- May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required.
- Partner with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
- May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness.
- May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice.
- May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success.
- Engage in a collaborative and ongoing process with People Leaders and cross-functional teams to measure and monitor readiness.
- Perform other duties as assigned.
- Comply with all policies and standards.
Requirements:
We are looking for a highly skilled and experienced Care Manager RN with a Graduate degree from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience. A Bachelor's degree in Nursing is preferred. The ideal candidate will have a strong background in nursing and a passion for delivering high-quality care to our members.
What We Offer:
As a Care Manager RN with Superior HealthPlan, you will have access to a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Equal Opportunity Employer:
Superior HealthPlan is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
