Clinical - Care Manager I (RN)

4 weeks ago

Buena Park, United States Axelon Services Corporation Full time
Location: Remote- PST, but MUST have CA licensure

SHIFT: 8a-5pm PST (No OT required)

*Attention: This is a 60 day contract position. Must have CA RN licensure. Can live anywhere in the US but must work West Coast hours.

**Remote telephonic Case Management experience HIGHLY Preferred by the Hiring Manager**

Job Description: Description - External
Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care

Pay rate - $$43.12

" Develop, assess and adjust, as necessary, the care plan and promote desired outcome
" Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
" Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
" Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
" Provide patient and provider education
" Facilitate member access to community based services
" Monitor referrals made to community based organizations, medical care and other services to support the members overall care management plan
" Actively participate in integrated team care management rounds
" Identify related risk management quality concerns and report these scenarios to the appropriate resources
" Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Qualifications - External

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor s degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.

Licenses/Certifications: Current state s RN license.

Walk me through the day to day responsibilities of this the role and a description of the project:
  • Outreaching member to enroll them in CM program
  • Building care plans, medication review, assessments care plans
Describe the performance expectations/metrics for this individual and their team:
  • 20 calls/day
Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1. Time Management (work fast-paced environment) 1. Technical skills 2. Works independently 2. 3. Work remotely in telephonic CM 3. Education Requirement: Associate s degree Education Preferred: Software Skills Required: Microsoft Office Suites Required Certifications: Must have CA RN licensure. Required Testing:

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