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Care Manager RN

2 months ago

Pittsburgh, Pennsylvania, United States Talent Software Services Full time
Job Summary:

Talent Software Services is seeking a skilled Care Manager RN to join our team on a contract basis. This opportunity is 100% remote and offers a strong chance for long-term extension.

Position Summary:

This role ensures that members with complex medical and/or psychosocial needs have access to high-quality, cost-effective healthcare. The successful candidate will assist in the holistic assessment, planning, arranging, coordinating, monitoring, and evaluation of outcomes and activities necessary to facilitate member access to healthcare services.

Key Responsibilities:
  • Communicate effectively with members, Case Management Specialists, Management Team, Physician Advisors, and other interdepartmental contacts.
  • Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States.
  • Educate members on their illness/disease impact and promote positive health outcomes.
  • Collaborate with Primary Care Physicians, Medical Specialists, Home Health, and other ancillary healthcare providers to coordinate member care.
  • Collect member medical information and use clinical judgment to determine unmet member needs.
  • Develop individualized plans of care to meet the specific needs of each member.
  • Anticipate member needs and continually assess and monitor progress toward goals and care plan status.
  • Communicate and collaborate with other payers to create a collaborative approach to care management and benefit coordination.
Qualifications:

Bachelor's degree in nursing or RN certification or master's degree in Social Work and 3 years experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.

3-5 years of experience working in Acute Care/Managed Care/

Professionally Licensed Nurse

Preferred:

Bilingual English/Spanish language skills.

Case Management Certification