RN Case Manager

About the Role

The RN Case Manager is primarily responsible for the daily management and support of Case Management strategies for care coordination for a group of members associated with a Medicare Advantage plan. This role involves visiting patients (in person and/or telephonically) to ensure proper nursing care, consulting with physicians, and coordinating with healthcare team members to assess, plan, implement, and evaluate patient care plans. The ideal candidate is a self-starter, team player, and able to manage multiple priorities with minimal supervision.

Responsibilities

• Complete Health Risk Assessments for assigned members.
• Initiate, update, and revise care plans as needed.
• Maintain a caseload of patients as assigned.
• Evaluate, coordinate, and plan patient care in collaboration with an interdisciplinary health team; reassess and revise plans of care as needed.
• Provide patient/family education based on identified learning needs using available teaching resources.
• Coordinate outpatient discharge planning based on patient needs, clinical circumstances, and benefit coverage.
• Participate in Managed Care-related audits and generate, maintain, and track reports/documents via MS Office programs.
• Perform improvement projects involving data collection, analysis, and preparation of audit findings and reports.
• Participate in patient care conferences, committee meetings, and educational programs to maintain professional competency.
• Apply medical management criteria correctly.
• Research clinical questions from employers, members, and payers as required.
• Educate members on health access options.
• Respond to, manage, and resolve day-to-day problems in care coordination and communicate effectively with facilities/homes.
• Perform other duties as assigned.

Qualifications

• Minimum of 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
• 2 years of managed care experience required.
• Minimum of 3-5 years’ experience in case management in a managed care environment, preferably with a managed care organization or similar facility, preferred.

Education

• Graduate of an accredited RN program.
• Bachelor’s Degree preferred.

Licensure/Certifications

• Current license to practice as a registered nurse in the assigned state.
• Current CCM license, preferred.
• CPR for Healthcare Professionals certification.
• Current valid driver’s license.
• Current motor vehicle insurance.

Benefits

• Annual performance wage increases.
• 401k retirement plan with a company match.
• Medical, dental, and vision insurance.
• $50,000 basic life insurance – paid by the company.
• Paid time off.
• UKG Wallet – access your pay faster!
• Holiday pay.
• Telehealth through 98point6 – free to all employees.
• Continuing Education opportunities.
• Career Advancement Opportunities.