Registered Nurse – Care Manager

Role Overview

• The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.
• Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.
• Authorizes covered services and coordinates care regardless of payer.
• Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
• Works with member/family to maintain the most independent living situation possible.
• Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
• Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
• Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
• Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
• Ensures appropriate, safe plan for members’ discharge from their plan.
• Identifies same day grievances, investigates and documents accordingly.
• Documents any grievance according to plan policy.
• Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).

Requirements

• Associates degree in Nursing from an accredited nursing program required
• Bachelor's degree in Nursing preferred
• Three (3) years of experience as a registered nurse required
• Clinical experience in geriatrics and/or managed long-term care experience preferred
• Experience using multiple languages may be required based on operational needs
• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
• Ability to communicate effectively with a diverse group of individuals
• Ability to multi-task and work independently within a team environment
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
• Strong understanding and sensitivity of all cultures and demographic diversity

Benefits

• Health insurance
• 401(k) matching
• Flexible working hours
• Paid time off
• Substantial and comprehensive total rewards package