RN Care Manager

SGS_JOB_2479

Nursing
 Delaware
Care coordination and case management
Face-to-face and telephonic member assessments
Medicare and Medicaid program knowledge
Managed care planning
HIPAA and regulatory compliance
Proficiency in MS Office (Word
Excel
Outlook)

Contract - 12 Month (Possible Extension)

Location - Wilmington, DE 19801. Experienced and compassionate healthcare professionals skilled in conducting face-to-face and telephonic assessments for members with chronic and complex conditions. Proven ability to coordinate care across healthcare settings, develop individualized care plans, and connect members with community resources. Adept at supporting high-risk populations through effective care management strategies, documentation, and compliance with state and federal healthcare guidelines. This job works directly with providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted in relation to quality and care costs. The incumbent could work in a physician’s office, visit physician practices on a routine basis, work within a hospital setting and/or visit the member’s home. This job directly helps members with the highest risk scores to coordinate care and navigate the healthcare system by recommending and/or implementing interventions related to the improvement of medical care and costs. Additional Information • Candidate must take "Care Manager" assessment in Glider. Please include link in candidate submit form. • Contract to hire opportunity. Manager starts to look at candidates at the 3-month mark to see if they are fit and starts considering hiring. • Will extend out 3 months at a time until hired full time. • Please include candidate's conversion salary (range between ($50,200-$90,300) • USC ONLY • Candidate must be located within either New Castle County.

Job Responsibilities:

  • Travel to members’ homes, nursing facilities, and other community-based settings to complete face-to-face needs assessments with subsequent telephonic contact with the member in accordance with state and national guidelines, policies, procedures, and protocols.
  • Assess, plan, coordinate, implement and evaluate care for eligible members with chronic and complex health care, social service and custodial needs in a nursing facility or home and community-based care setting.
  • Coordinate care across the continuum of services and assisting members physical, behavioral, long-term services and support (LTSS), social, and psychosocial needs in the safest, least restrictive way possible while considering the most cost-effective way to address those needs.
  • Facilitate authorization, coordination, continuity and appropriateness of care and services in community or HCBS.
  • Facilitate transitions to alternate care settings such as hospitals to home, nursing facility to community setting using an integrated care team to address the member’s specific needs.
  • Educate members or caregivers regarding health care needs, available benefits, resources, and services including available options for long term care community or facility-based service delivery.
  • Provide education, resources, and assistance to help members achieve goals as outlined in their plan of care and to overcome obstacles to achieving optimal care in the least restrictive environment.
  • Develop a plan of care in conjunction with members or caregivers to identify services to meet the member’s specific needs, and goals.
  • Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
  • Collaborate with the member's health care and service delivery team including the DSHP Plus LTSS Member Advocate, ICT, and discharge planners, to coordinate the care needs and community resources for the member to maintain the member in the least restrictive safe environment possible.
  • Assist members in developing, implementing, and amending a back-up plan for gaps in provider coverage.
  • Ensure approved support services are being provided as outlined in the plan of care.
  • Evaluate the effectiveness of the service plan and make appropriate revisions as needed in accordance with per policy & procedures and state contractual requirements.
  • Assist members in overcoming obstacles to optimal care through connection with community resources, including communicating with providers and formulating an appropriate action plan.
  • Document all case management services and intervention in the electronic health record.
  • Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.
  • Perform other duties as assigned/requested.

Skills:

  • Care coordination and case management, Face-to-face and telephonic member assessments, Medicare and Medicaid program knowledge, Managed care planning, HIPAA and regulatory compliance, Proficiency in MS Office (Word, Excel, Outlook)

Education/Experience:

  • Registered Nurse and 2 years of experience in long-term care, home health, hospice, public health, or assisted living
  • One year in home clinical or case management experience
  • Medicare and Medicaid experience
  • Managed care experience
  • Working flexible hours to meet member’s needs
  • Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)
  • Reliable transportation daily to be able to travel within assigned territory
  • Ability to meet regulatory deadlines.
  • Has a dedicated homework space used only for business purposes and is able to comply with all telecommuter policies.
  • Experience in geriatric special needs, behavioral health, home health
  • Understanding of the importance of cultural competency in addressing targeted populations.
  • Experience with electronic documentation systems(s)
  • Experience with cost neutrality and budgeting
  • Must be willing to travel throughout the state (may only need to travel 2-3 times a week depending on schedule)
  • Must have reliable transportation
  • Must be able to communicate clearly to members - will be tasked with conducting assessments with members over the phone
  • Must have good computer skills
  • Must be very organized

Related Jobs

Nurse Practitioner Float

Nursing
 Massachusetts
06+ Months Extendable

Location : Hudson, MA 01749 Shift: Part-time: 17-28 hours/week, including every other weekend Dress Code: Business Casual Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning.

NP
Nurse Practitioner
FNP
Family Nurse Practitioner
Long term Care
Primary care

Nurse Practitioner Float

Nursing
 Massachusetts
06+ Months Extendable

Location : Wilmington, MA 01887 Shift: Part-time: 17-28 hours/week, including every other weekend Dress Code: Business Casual Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning.

NP
Nurse Practitioner
FNP
Family Nurse Practitioner
Long term Care
Primary care

Nurse Practitioner

Nursing
 Virginia
5-6 Months

Location: Charlottesville, VA Seeking a skilled and autonomous Nurse Practitioner to provide evidence-based primary and family care in collaboration with a multidisciplinary clinical team. The role involves comprehensive patient assessment, diagnosis, treatment, and health education to improve patient outcomes and support overall wellness.

Proficient with electronic medical records (EMR) and healthcare technology
Strong commitment to patient engagement and education
Knowledge of chronic disease management and quality measurement

Nurse Practitioner

Nursing
 Massachusetts
05 Months

Location: Medway, MA Seeking a skilled and autonomous Nurse Practitioner to provide evidence-based primary and family care in collaboration with a multidisciplinary clinical team. The role involves comprehensive patient assessment, diagnosis, treatment, and health education to improve patient outcomes and support overall wellness.

Strong commitment to patient engagement and education
Proficient with electronic medical records (EMR) and healthcare technology
Knowledge of chronic disease management and quality measurement

Nurse Practitioner

Nursing
 Massachusetts
04 Months

Location: Leominster, MA Seeking a skilled and autonomous Nurse Practitioner to provide evidence-based primary and family care in collaboration with a multidisciplinary clinical team. The role involves comprehensive patient assessment, diagnosis, treatment, and health education to improve patient outcomes and support overall wellness.

Proficient with electronic medical records (EMR)
Excellent verbal
written
and electronic communication skills
Knowledge of chronic disease management and quality measurement

Nurse Practitioner

Nursing
 Massachusetts
06 Months

Location: Worcester, MA Seeking a skilled and autonomous Nurse Practitioner to provide evidence-based primary and family care in collaboration with a multidisciplinary clinical team. The role involves comprehensive patient assessment, diagnosis, treatment, and health education to improve patient outcomes and support overall wellness.

Communication
Proficient with electronic medical records
Strong clinical judgment and diagnostic ability

Nurse Practitioner Float

Nursing
 Florida
06+ Months Extendable

Location : Callahan, FL 32011. Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning.

NP
Nurse Practitioner
FNP
Family Nurse Practitioner
Long term Care
Primary care

Pharmacy Tech I: Materials Coordinator

Nursing
 California
$20-21/hr.
03+ Months Extendable

Location (mandatory): Redlands, CA 92374 Ensure pharmacy pick stations are properly stocked with medication and supplies. Place approved orders for shipping supplies. Assist in maintaining dispensing and back stock refrigerators in a well-organized manner. Provide Operations Assistants with adequate packing supplies and ensure packages are stocked appropriately. Work with Inventory CDR to assist in receiving, posting, put-away, and cycle counting functions. Monitor and pull short dated or expired products from active inventory.

Pharmacy Technician
Pharma Technician
Pharmacy

Healthcare Consultant I - Citrus Park/ Carolwood Area

Nursing
 Florida
05+ Months Extendable

Location (mandatory): Citrus Park or Carolwood area (Florida) - Candidates must reside in Hillsborough County, FL and live within 2-3 miles of the 33624/33625 zip code. We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and complex members. Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Case Management Coordinators will determine appropriate services and support due to member’s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.

Healthcare Consultant
Healthcare Professional
Case Management
Case Manager
logo

At SGS Consulting, we go beyond resume-job matches, creating meaningful connections and pathways for individuals to thrive in defining careers.


2025. All right reserved.
logologologologo