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Registered Nurse Case Manager
2 months ago
We are committed to delivering high-quality medical care to all patients. As a Case Manager, you will be part of a team that shares your passion for helping people achieve better health.
Job SummaryThe primary responsibility of the Case Manager is to identify, screen, track, monitor, and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan.
Key Responsibilities- Collaborate with the interdisciplinary care team to establish an individualized care plan for members with interventions to assist the member in meeting short and long-term goals.
- Engage patients, families, and caregivers to ensure a well-coordinated care plan is established.
- Identify member needs, develop care plans, and prioritize goals, using evidence-based practice to develop interventions while considering member barriers with guidance from medical directors and Manager of Care Management.
- Make outbound calls to assess member health status, identify gaps or barriers in care plans.
- Coordinate visits with PCP and specialists on a limited basis, perform visual assessments for skin checks on exposed skin, and conduct home safety evaluations.
- Enter timely and accurate data into designated care management applications and maintain audit scores of 90% or better on a monthly basis.
- Adhere to organizational and departmental policies and procedures.
- Decision-making is based on regulatory requirements, policies, and procedures, and current clinical guidelines.
- Maintain current knowledge of health plan benefits and provider network, including inclusions and exclusions in contract terms.
- Monitor for quality concerns regarding member care and report as per policy and procedure.
- Bachelor's degree in Nursing, and/or Associate's degree in Nursing combined with 2+ years of experience and/or Nursing Diploma.
- 2+ years of managed care and/or case management experience.
- Proven knowledge of utilization management, quality improvement, and discharge planning.
- Proficient with Microsoft Office applications, including Outlook, Word, and Excel.
- Proven ability to utilize critical thinking skills, nursing judgment, and decision-making skills.
- Proven ability to problem-solve and identify community resources.
- Proven planning, organizing, conflict resolution, negotiating, and interpersonal skills.
- Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area.
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease.
We are an equal employment opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
