Registered Nurse, High Risk Case Manager

Role Overview

• Manages the members health, emotional and social needs across the health care continuum (longitudinal support) to achieve the optimal health management in the following areas: clinical, financial, operational, and member experience.
• Assess, triage and identify care coordination and chronic complex disease education needs based on member specific needs.
• Provides care based on the best evidence available and may participate in research activities within clinical /case manager practice.
• Contributes to society through activities that lead to excellent members outcomes through timely, effective, efficient, equitable, and safe care.
• Educates internal members of the health care team on care management and managed care concepts.
• Promotes a more active and informed role in patient self-care; navigates patients identified as high-risk across the continuum, longitudinally.
• Completes assessment and reassessments according to patient need and as outlined in policy and according to accreditation standards.
• Interacts with all levels of staff in a variety of departments, physicians, payers, members, families and external contacts, such as employees of other health care institutions, community providers and agencies, concerning the health care and case management needs of the member.

Requirements

• Must possess knowledge normally obtained through the completion of a bachelor's degree in nursing and/or related field like community health, education, or health management.
• Must possess a current, valid RN license in state of practice, temporary/interim RN license in state of practice, or compact RN licensure for current state of practice.
• Certification for BLS is required for programs that are embedded in a clinical setting or conduct member community or home visit.
• Must possess knowledge of managing and coordinating care for members with chronic complex disease processes as normally obtained with 3 or more years’ experience providing direct patient care patient with chronic complex conditions in the acute care setting, nurse navigator and/or case management field.
• Requires excellent organizational skills, case management and clinical knowledge regarding specialty care services, as well as care coordination of services, legal and financial aspects of diagnostic services and health services in specialty area.
• Must possess ability to make autonomous decisions utilizing excellent clinical judgment.
• Must possess highly effective interpersonal and communication skills.
• Requires effective communication and writing skills, good time management skills and knowledge of word processing and database software applications.
• May require off-site travel with personal vehicle (i.e. Corporate locations or member face-to-face visits within their homes, physicians’ offices, and/or community resources).

Benefits

• Total Rewards
• Comprehensive benefit package
• Professional development opportunities