Care Manager ToC (RN)

About the role

This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high risk and special needs members.

Responsibilities

• Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
• Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs.
• Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management.
• Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
• Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs.
• Utilizes clinical judgment to discharge members from care management according to plan policies and procedures.
• Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems.
• Collections, evaluates, and reports clinical, functional and program activity as applicable.
• Identify cases to assess for impact of care management services, may assist in the collection of data.
• Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning.
• Coordinates and communicates with community support and social service systems for members.
• Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
• Aids in the development of policies and procedures related to care management.
• Communicate effectively with supervisor/manager regarding departmental issues, member issues, program status, compliance issues, etc.

Requirements

• The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.
• Ability to conduct presentations and training before small and large groups.
• Knowledge of the Americans with Disabilities Act of 1990.
• Demonstrated skill in written and oral communication to include presentations and training before small and large groups.

Education And Work Experience

• Registered Nurse with current state license.
• 2+ years of clinical nursing experience in acute care or community setting.
• Demonstrated experience helping members using community agencies.
• 2 years of care management experience.
• Knowledge of Managed Care Programs (preferred).
• BSN (preferred).
• CCM (preferred).

Secondary Functions

• Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures.
• Demonstrates an understanding of the functions of other departments, communicates with other departments appropriately and maintains positive working relationships.
• Identifies and reports gaps in the service delivery system.

Benefits

Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.