Care Management RN (Compact Licensed)

Company Description Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity. Position Responsibilities Specific 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)Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination, case managementEducate member/caregivers about treatment options, community resources, insurance benefits, etcEngage member to complete health and psychosocial assessment, taking into account the cultural and linguistic needs of each memberAssess, develop, implement, document, coordinate, monitor, manage, evaluate and update comprehensive individualized care plans (ICP) designed to provide evidence based care to meet member needsEmploy ongoing assessment and documentation to evaluate member response to and progress on the ICPIdentify and manage barriers to achievement of care plan goalsIdentify and implement effective interventions based on clinical standards and best practicesCollaborate 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 outcomesAct as a liaison to collaborate with facility based case managers, provider and care transition/ discharge planners to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective mannerCoordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of servicesAppropriately terminate care coordination services based upon established case closure guidelinesProvide clinical oversight and direction to unlicensed team members as appropriate General Perform daily work with a focus on the core principles of managed care: patient education, wellness and prevention programs, early screening and intervention, continuity of careWork proactively to expedite the care processIdentify priorities and necessary processes to triage and deliver workEmpower members to manage and improve their health, wellness, safety, adaptation, and self-careAssess and interpret member needs and identify appropriate, cost-effective solutionsIdentify and remediate gaps or delays in care/ serviceAdvocate for treatment plans that are appropriate and cost-effectiveWork with low-income/ vulnerable populations to ensure access to care and address unmet needsGather and evaluate clinical information to assess and expedite referrals within the healthcare system including consideration of alternate levels of care and serviceFacilitate timely and appropriate care and effective discharge planningWork collaboratively across the health care spectrum to improve quality of careLeverage experience/ expertise to observe performance and suggest improvement initiativesEnsure understanding of industry standard competencies and performance metrics to optimize decisions and clinical outcomesEnsure individual and team performance meets or exceeds the performance competencies and metricsContribute actively and effectively to team discussionsShare knowledge and expertise, willingly and collaborativelProvide outstanding customer service, internally and externallyFollow and maintain compliance with regulatory agency requirements Competencies Position Qualifications: Ability to translate member needs and care gaps into a comprehensive member centered plan of careAbility to collaborate with others, exercising sensitivity and discretion as neededStrong understanding of managed care environment with population management as a key strategyStrong understanding of the community resource network for supporting at risk member needsAbility to collect, stage and analyze data to identify gaps and prioritize interventionsAbility to work under pressure while managing competing demands and deadlinesWell organized with meticulous attention to detailStrong sense of ownership, urgency, and driveThe ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families. Excellent analytical-thinking/problem-solving skills.The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads.The ability to offer positive customer service to every internal and external customer Experience Current unencumbered Compact RN licenseMinimum of 5+ years of acute clinical experienceMinimum 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 preferredStrong knowledge of care management/ population health processes and industry best practiceDetailed knowledge of SDOH frameworks and community resource networksHMO and risk contracting experience preferredIn-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 Physical Requirements Must be able to sit in a chair for extended periods of timeMust be able to speak so that you are able to accurately express ideas by means of the spoken wordMust be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devicesMust have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouseMust be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information typesMust be able to fluently communicate both verbally and in writing using the English language Time Zone: Eastern, Central or Mountain Other Information Expected Hours of Work: Monday - Friday; 8 am – 5 pm CST; with ability to adjust to Client schedules as neededTravel: May be required, as needed by ClientDirect Reports: NoneSalary Range: $70,000 - $100,000 EEO Statement It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.