Case Manager RN

JOB REQUIREMENTS: SUMMARY: The telephonic RN Case Manager position is

responsible for utilizing the nursing process in the development of

member treatment plans. The Case Manager will establish member goals and

implement interventions to optimize member health care across an

assigned patient case- load in order to promote high quality healthcare

appropriate for the member\'s clinical needs. RESPONSIBILITIES/TASKS: \*

Improve member health outcomes by successfully managing a member

caseload from a variety of care management referral sources. \* Conduct

telephonic member assessments to identify member care coordination

needs; develop, with member and provider as appropriate, a specific care

management plan to address member goals and interventions as identified

during assessments. \* Manage members with chronic illness,

co-morbidities, and/or complex health conditions to ensure the member

receives quality health care in the most cost- effective and efficient

delivery of healthcare benefits. \* Provide member and/or caregiver

self- management strategies and ensure member receives appropriate level

of post -care education to include education on condition(s),

medication, benefits, and resources to optimize highest level of

function. \* Identify potential gaps in member care through education,

empowerment and/or motivational interviewing techniques. \* Coordinate

internal and external resources to meet identified needs by assisting

member with obtaining any DME supplies, pharmacy referrals, and / or

community resources. \* Interfaces with Medical Directors and other

interdisciplinary team members in the development of care management

treatment plans. \* Familiarity with the quality management process and

customer- focus care to improve STARS and HEDIS outcomes. \* Continues

professional development by attending relevant educational programs at

least annually. \* Ability to meet and/ or exceed established

productivity metrics and standards. This position description identifies

the responsibilities and tasks typically associated with the performance

of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS: EDUCATION: \* Nursing diploma or Associates

degree in nursing required. \* Bachelor\'s degree in nursing or related

field preferred. \* Certification in Case Management (CCM) preferred.

EXPERIENCE: \* Two (2) to four (4) years of related clinical experience

required. \* One (1) to three (3) years case management experience

required. \* Managed care experience in Medicare case management

preferred. \* Experience in med surgical, preventive care, chronic

condition education, homecare, critical care and public health

preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: \* Must have basic

computer knowledge, typing ability, and proficiency in Microsoft Office

products. \* Effective written and verbal communication skills. Ability

to work independently yet remain engaged with team members as needed to

meet performance metrics. \* Effective organizational skills, ability to

prioritize multiple tasks while maintaining flexibility. \* Knowledge of

Case Management and Disease Management principles. \* Knowledge of

medical surgical principals, discharge planning, chronic diseases and

clinical programs. \* Knowledge of HIPAA, American Disability Act,

Clinical ethics, COB rules and Medical Policy. \* Familiarity with

InterQual criteria, crisis call interventions, evidence-based guidelines

and alternate care. \* Knowledge of educational assessments and learning

strategies. WORKING CONDITIONS: Work is performed in an office setting

and or hybrid of a work from home model with productivity and quality

expectations. Work requires sitting for extended periods of time,

talking on the tel To view the full job description please use the link

below.

\*\*\*\*\* APPLIC TION INSTRUCTIONS: Apply Online: