Active unrestricted Registered Nurse (RN) license required, with Compact RN license preferred.
Minimum of 2 years of direct clinical care experience.
Proficient in case management processes and techniques.
Strong verbal and written communication skills are essential for telephonic engagement.
Experienced in health advocacy and consumer education initiatives.
Responsibilities
Establish collaborative relationships with clients, families, and healthcare providers.
Promote consumerism through education and advocacy to support health improvement.
Assess members' health status and identify barriers to care, creating a patient-centered management plan.
Implement, coordinate, and monitor care management plans continually for effectiveness.
Ensure adherence to professional practice standards and care management policies.
Engage in ongoing training and demonstrate clinical expertise through continuing education.
Monitor care management activities and performance metrics diligently.
Benefits
40-hour work schedule, Monday to Friday, with weekends and company holidays off.
Opportunities for professional development through training initiatives and continuing education.
Full Job Description
Description
Government Programs Care Manager III. For this position, formerly Nurse Case Management Senior Analyst, through the care management process, will promote the improvement of health outcomes to SNP members. Also assist those members experiencing the burdens of illness and injury.
The Care Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individuals health needs within case load assignments of a defined population.
The Care Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced.
Ability to work independently and effectively communicate to internal and external customers in a telephonic environment.
Responsibilities:
Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes.
Promote consumerism through education and health advocacy.
Assesses members health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric care management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
Implements, coordinates, monitor and evaluate the care management plan on an ongoing, appropriate basis.
Adheres to professional practice within scope of licensure and certification quality assurance standards and all care management policy and procedures.
Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
Demonstrates sensitivity to culturally diverse situations, clients and customers.
All care management activities and performance metrics are monitored.
40 hour schedule that supports M-F, 8 working hours each work day (exclusion of company holidays)
Minimum requirements:
Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Compact RN license a required for this role.
Two years full-time equivalent of direct clinical care to the consumer.
