Health Plan Care Manager, RN / LSW

Role Overview

• Oversee and coordinate the care of assigned ISNP members, ensuring they receive timely and appropriate care as dictated by the SNP Model of Care.
• Perform initial, annual, transition of care (TOC) and change in condition health risk assessments (HRA) for ISNP care managed caseload.
• Formulate and implement a member centric holistic care plan that addresses identified needs by assessing the member/representative/family needs, issues, resources and care goals; determining and educating on the choices available to the individual member.
• Collaborate with the interdisciplinary team (ICT) which may include Medical Director, PCP, nurse practitioners/physician assistants, pharmacy, dietary, social workers, other clinical and non-clinical disciplines, facility staff, member representatives and family to establish, revise and continuously evaluate the member centric care plan.

Requirements

• Licensed master’s in social work or licensed Registered Nurse (RN) with a minimum of a bachelor’s degree
• Clinicians must be clinically licensed in the State they are managing members or have compact licensure
• Certified Case Management (CCM) certification or willing to obtain within 1 year of hire (company sponsored)
• Active drivers license as this is NOT a remote role and must have reliable transportation to enable face to face visit to members in facilities
• Minimum of 3-5 years in Case/Care Management preferred and/or 5+ years of direct patient care
• Knowledge of value-based care, fee for service and Medicare Advantage/Dual (Medicare/Medicaid), NCQA, HEDIS and basic Utilization Management functions
• Expertise in care coordination for geriatric and high-risk populations
• Ability and experience utilizing a variety of applications and databases to fulfill care management requirements, and documentation.

Benefits

• Health insurance
• Flexible work arrangements