Normal Working Hours: 8:00am through 4:30pm in time zone of residence with a 10:30am-7:00pm EST rotation approximately once per Quarter.
No travel is expected with this position.
The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.
The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills.
The responsibilities of this Case Manager RN position are to:
-Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.
-Conduct comprehensive clinical assessments.
-Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services.
-Advocate for patients to the full extent of existing health care coverage.
-Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency.
-Identify and escalate quality of care issues through established channels.
-Provide an expected very high level of customer service.
-Utilize assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change.
-Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
-Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
Required Qualifications
- Must have active, current and unrestricted RN licensure in state of residence
- Willingness and ability to obtain additional state licenses upon hire (paid for by the company)
- 3+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ER, ICU experience).
- 3+ years of experience with all types of Microsoft Office including PowerPoint, Excel, and Word
- Must be able to work Monday through Friday, 8:00am to 4:30pm in time zone of residence
- Must be willing to work one late shift per quarter until 7pm EST
Preferred Qualifications
- Compact RN License
- Certified Case Manager (CCM)
- Managed Care experience
- Home Care experience
- Telephonic case management and/or telephonic customer service center experience
Education
- Associate Degree with RN licensure required; BSN preferred
