Care Management RN (Compact Licensed)

Position Responsibilities

• Manage expenses, facilitate access and improve quality of life for persons with long-term chronic conditions and/ or high risk, high cost disease states (Disease and/ or Chronic Condition Management)
• Work with patients in distinct populations and sub-populations to promote global outcomes, optimize health, manage care and control costs (Population Health)
• Afford member/caregivers about treatment options, community resources, insurance benefits, etc
• Engage member to complete health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
• Assess, develop, implement, document, coordinate, monitor, manage, evaluate and update comprehensive individualized care plans (ICP) designed to provide evidence based care to meet member needs
• Ongoing assessment and documentation to evaluate member response to and progress on the ICP
• Identify and manage barriers to achievement of care plan goals
• Identify and implement effective interventions based on clinical standards and best practices
• Collaborate with members of an inter-disciplinary care team (ICT) to identify member needs and opportunities that would benefit from care coordination to achieve goals and maximize member outcomes
• Engage in care coordination to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
• Coordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of services
• Properly terminate care coordination services based upon established case closure guidelines

Qualifications

• Current unencumbered Compact RN license
• Minimum of 5+ years of acute clinical experience
• Minimum 2 years’ experience in a managed care environment across multiple lines of business (Medicare Advantage, Managed Medicaid, Dual SNP, Commercial, etc.)
• 2+ years of care management experience in managed care environment, CM certification preferred
• Strong knowledge of care management/ population health processes and industry best practice
• Detailed knowledge of SDOH frameworks and community resource networks
• HMO and risk contracting experience preferred
• In-depth knowledge of current standard of medical practices and insurance benefit structures
• Excellent oral and written interpersonal/communication, internal/external customer-service, organizational, multitasking, and teamwork skills
• Proficiency in Microsoft Office