Senior Care Manager (RN)

Position Purpose

Affords complex care management activities based on member activities to achieve quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care. Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.

Responsibilities

• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs
• Makes sure care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals are monitored; collaborates with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
• Identifies problems/barriers for care management and appropriate care management interventions for escalated cases
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Reviews referrals information and intake assessments to develop appropriate care plans/service plans
• Performs telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
• Presents guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
• Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness

Requirements

Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 – 6 years of related experience. License/Certification RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Qualifications

Competent in assessing, planning, and implementing complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Skilled in developing and continuously assessing ongoing care plans / service plans and collaborating with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs. Skilled in coordinating and managing as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services. Skilled in monitoring care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborates with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs. Skilled in identifying problems/barriers for care management and appropriate care management interventions for escalated cases. Skilled in reviewing member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations. Skilled in reviewing referrals information and intake assessments to develop appropriate care plans/service plans. Skilled in performing telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources. Skilled in collaborating with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed. Skilled in collecting, documenting, and maintaining all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators. Skilled in providing and/or facilitating education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits. Skilled in presenting guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and providing coaching and shadowing opportunities to bridge gap between classroom training and field practice. Skilled in engaging and assisting New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success. Skilled in engaging in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness.

Skills

Skilled in assessing, planning, and implementing complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Skilled in developing and continuously assessing ongoing care plans / service plans and collaborating with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs. Skilled in coordinating and managing as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services. Skilled in monitoring care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborates with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs. Skilled in identifying problems/barriers for care management and appropriate care management interventions for escalated cases. Skilled in reviewing member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations. Skilled in reviewing referrals information and intake assessments to develop appropriate care plans/service plans. Skilled in performing telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources. Skilled in collaborating with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed. Skilled in collecting, documenting, and maintaining all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators. Skilled in providing and/or facilitating education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits. Skilled in presenting guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and providing coaching and shadowing opportunities to bridge gap between classroom training and field practice. Skilled in engaging and assisting New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success. Skilled in engaging in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness.

Benefits

Comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Pay

$75,300.00 - $135,400.00 per year

Schedule

Monday - Friday, 8am - 5pm