Clinical - Care Manager (RN)
3 weeks ago
SHIFT: Training 9am-5:30pm M-F, after training will be a set schedule 8 hours a day between 8am-8pm ET, Monday through Friday.
Duration: 6+ months, possible extension
Job Description: Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Education/Experience:
Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 4 years of related experience.
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
Walk me through the day to day responsibilities of this the role and a description of the project:
- Case management for specialty pharmacy. The candidate will not have a set list of patients to manage day after day. The work is generated by the day to day needs of the patients. Direct telephonic patient care. Counsel patient and caregivers on medication administration, side effects, disease state, and identify potential drug to drug interactions. Sometimes reaching out to providers to help facilitate addressing issues and follow-ups
Job Duties:
Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
Identifies problems/barriers to care and provide appropriate care management interventions
Coordinates as appropriate 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
Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned Required Skills/Experience: Preferred Skills/ Experience: 1. 4+ years of applicable nursing experience 1. Spanish-Speaking 2. 2. Pharmacy experience. 3. 3. Education Requirement: RN- Associate Degree Education Preferred: Software Skills Required: Microsoft Office, Required Certifications: RN Required Testing:
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