RN Case Manager

About the Role

The RN Case Manager is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members who are associated with a Medicare Advantage plan. This position requires a self-starter and team player who can manage multiple priorities, work with minimal supervision, and demonstrate excellent communication and presentation skills. The individual must adapt quickly to change and collaborate with multiple teams.

Responsibilities

• Visit (in person and/or telephonic) patients to ensure proper nursing care.
• Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims.
• Consult and coordinate with health care team members to assess, plan, implement, and evaluate patient care plans.
• Complete Health Risk Assessments for members as assigned.
• Initiate, update, and/or 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 in collaboration with other members of the health care team.
• Provide patient/family education based on identified learning needs utilizing available teaching resources.
• Provide education based on identified learning needs to members of the Home/Facility staff as needed.
• Coordinate outpatient discharge planning based on patient needs, clinical circumstances, and benefit coverage.
• Participate in all Managed Care related audits; generate, maintain, and track periodic and annual reports/documents via MS Office programs and emails to support the Care Coordination program.
• Perform improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports.
• Participate in patient care conferences, committee meetings, staff development, and educational programs to increase or maintain professional competency.
• Correctly apply medical management criteria.
• Research clinical questions from employers, members, and payers as required.
• Educate members on health access options.
• Respond, manage, and resolve day-to-day problems presented in care coordination and communicate effectively with the Facility/Home.
• Other duties as assigned.

Requirements

• 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 doing case management in a managed care environment, preferably with a managed care organization or like facility.

Qualifications

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