Registered Nurse ( RN ) - Medical Field Case Manager
5 - 7 years experience • Managed Care & Health Insurance
As a Field Case Manager, you will partner within our Clinical Team to deliver a collaborative process of assessment, planning, and advocacy to meet a members benefit plan and/or health needs in their home, hospital or other community location.
Fundamental Components include but are not limited to: -
Through the identification of members via analytics tools, member services or self-referrals, conducts comprehensive assessments of referred member's needs/eligibility.
Determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
Operates across a multi-disciplinary team, inclusive of other specialized clinicians, to overcome barriers to meeting health goals and objectives and ensuring optimal member health is achieved.
Consistently presents appropriate cases at Case Management Rounds to obtain multidisciplinary review in order to achieve optimal outcomes –
Identifies and escalates quality of care issues through established channels Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Knowledge and use of social and community resources to assist members in achieving optimal health are key to the role.
This position requires the Case Manager to conduct face to face visits with members enrolled in the case management program.
Must have experience in meeting members in their homes, community setting or healthcare facility. Comfortable travelling within a designated geographic area based on member location, up to 50 miles.
Minimum of three years case management experience preferred
5 years clinical practice experience required
2 years of Home Care/Hospice Care required Ability to travel within a designated geographic area for in-person case management activities
Excellent analytical and problem solving skills
Experience in using multiple online tools to capture care management plans, identify resources to support members and track activities.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
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