Senior Care Manager (RN)

Position Purpose

Affords complex care management 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.

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
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
• 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
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Makes sure all member information and care management activities are documented 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
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
• 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
• Performs other duties as assigned

Requirements

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

Qualifications

• Complies with all policies and standards

Skills

• Strong communication and interpersonal skills
• Ability to work independently and as part of a team
• Knowledge of healthcare regulations and compliance
• Proficiency in healthcare software and technology

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

Pay

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.

Schedule

Monday - Friday, 8am - 5pm