Care Management RN (MN 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)
• Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination, case management
• Educate 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
• Employ 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
• Act 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 manner
• Coordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of services
• Appropriately terminate care coordination services based upon established case closure guidelines
• Provide clinical oversight and direction to unlicensed team members as appropriate

General Duties

• 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 care
• Work proactively to expedite the care process
• Identify priorities and necessary processes to triage and deliver work
• Empower members to manage and improve their health, wellness, safety, adaptation, and self-care
• Assess and interpret member needs and identify appropriate, cost-effective solutions
• Identify and remediate gaps or delays in care/ service
• Advocate for treatment plans that are appropriate and cost-effective
• Work with low-income/ vulnerable populations to ensure access to care and address unmet needs
• Gather and evaluate clinical information to assess and expedite referrals within the healthcare system including consideration of alternate levels of care and service
• Facilitate timely and appropriate care and effective discharge planning
• Work collaboratively across the health care spectrum to improve quality of care
• Leverage experience/ expertise to observe performance and suggest improvement initiatives
• Ensure understanding of industry standard competencies and performance metrics to optimize decisions and clinical outcomes
• Ensure individual and team performance meets or exceeds the performance competencies and metrics
• Contribute actively and effectively to team discussions
• Share knowledge and expertise, willingly and collaborative
• Provide outstanding customer service, internally and externally
• Follow and maintain compliance with regulatory agency requirements

Qualifications

• Ability to translate member needs and care gaps into a comprehensive member centered plan of care
• Ability to collaborate with others, exercising sensitivity and discretion as needed
• Strong understanding of managed care environment with population management as a key strategy
• Strong understanding of the community resource network for supporting at risk member needs
• Ability to collect, stage and analyze data to identify gaps and prioritize interventions
• Ability to work under pressure while managing competing demands and deadlines
• Well organized with meticulous attention to detail
• Strong sense of ownership, urgency, and drive
• The 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 & Requirements

• Current unencumbered Minnesota 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

Physical Requirements

• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must 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 mouse
• Must 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 types
• Must be able to fluently communicate both verbally and in writing using the English language

Schedule

• Monday - Friday; 8 am – 5 pm CST; with ability to adjust to Client schedules as needed

Pay

$70,000 - $100,000