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RN Case Manager
2 months 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 develop and implement personalized care plans that empower individuals to manage their chronic conditions effectively.
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 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, ensuring 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).
- Bachelor's degree in a 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.
Working Conditions
- Ability to cover any work shift.
- Ability to work overtime, if needed.
- Onsite: works within a standard office environment.
- Remote: private and secure workspace and workstation with high-speed internet is required.
