Complex Case Manager RN (Remote)

About the role

This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizes data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources.

Responsibilities

• Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
• Create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
• Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
• Maintain current knowledge and adhere to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
• Other duties as assigned or requested.

Requirements

• Required: High School Diploma/GED
• Preferred: Bachelor's Degree in Nursing
• Required: 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
• PREFERRED: Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
• Preferred: Understanding of the importance of cultural competency in addressing targeted populations
• Required: Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.

Qualifications

• Required: Certification in Case Management
• Preferred: Broad knowledge of disease processes
• Preferred: Understanding of healthcare costs and the broader healthcare service delivery system
• Preferred: Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
• Preferred: Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
• Preferred: Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills
• Preferred: Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Skills

• Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
• Broad knowledge of disease processes
• Understanding of healthcare costs and the broader healthcare service delivery system
• Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
• Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
• Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills
• Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Benefits

Not specified

Pay

$72,700.00 - $116,600.00

Schedule

Not specified