Location : REMOTE with PA state RN License.
Shift: Monday-Friday 8am-5pm EST
Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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.
Job Responsibilities:
- Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
- Uses clinical tools and information/data review to conduct an evaluation of members’ needs and benefits.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
- Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
- Collaborate with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
- Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Skills:
- Minimum 3-5 years clinical practical experience
- Minimum 2-3 years CM, discharge planning and/or home health care coordination experience
- Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
- Bilingual desired
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal skills.
- Ability to work independently
- Effective computer skills including navigating multiple systems and keyboarding
- Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
Education/Experience:
- Registered Nurse with active state license in good standing within the region where job duties are performed is required.
- Must be license in state of PA
- If residing in a compact licensure state, it is preferred that RN license is part of the compact.
- Additional state licenses are preferred.
- Certified Case Manager is preferred.
