Care Manager, Registered Nurse

Role Overview

• Engage telephonically with members, caregivers, and providers to develop a comprehensive plan of care, identify key strategic interventions, and address the members needs at various stages along the care continuum.
• Serve as an extension of the care team by collaborating with PCPs, specialists, other clinicians, and member to meet health care goals through development and implementation of Care Plans.
• Assess the member’s ongoing care needs and progress towards goals throughout the plan duration and make revisions as needed to address changes in the member’s condition, lack of progress toward goals of the care plan, preference changes, and transitions in care settings.
• Coordinates plan of care with goals of member stabilization, decreased admissions, medication management, behavior change and ability to self-manage.
• Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member.
• Identify relevant benefit and community resources, evaluates Social determinants of Health and facilitates referrals based on member need.
• Assist the member in coordination of any additional tests, images and consults with specialists.
• Perform medication reconciliation at the onset of care plan, after changes in health status, and every thirty days during the life cycle of the care plan, assessing for efficacy and drug interactions/side effects.
• Facilitate and monitor the transition of care which involves moving the member from one healthcare practitioner to another as their healthcare needs change.
• Implements and oversees the agreed upon plan of care as well as coordinates member follow-up post discharge.
• Utilize established documentation standards to maintain quality of care plan documentation to include member progress toward their established state of being and barriers to achievement of care plan objectives and outcomes.
• Abide by Value Based Care Management Program Description and Guidelines.
• Meet productivity and quality metrics as outlined by leadership for each year.
• Complete mandatory training and annual competency testing.
• Actively participate in team huddles and contribute to clinical learning.
• Remain current on clinical knowledge via self-directed learning.

Requirements

• Current multi-state compact Registered Nurse licensure in state of residence is required, with ability to obtain additional licenses without restriction.
• BSN preferred.
• Training in motivational interviewing preferred.
• Minimum 3-5 years varied clinical experience with telephonic Case Management experience strongly preferred.
• Demonstrates computer competencies to include electronic medical records, word processing, spreadsheet, presentation preparation, and.
• Demonstrated ability to learn customized computer applications.
• Maximize all technology inclusive of Microsoft Teams, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, and all other relevant unified communication technologies.

Benefits

• Comprehensive benefits package