Care Manager (RN) - J01007

Position Title: Care Manager (RN)

Location: Remote

Duration: 12+ Months Contract

Possibility to extend or convert?: Yes for extension and conversion

Estimated Start Date: Jan 5th

Pay Rate: $45.00/hr on W2

Shift Schedule: EST working hours 8AM-5PM

Must Have

• Required: Graduation for an accredited Nursing program or bachelors degree
• Required: Registered Nurse
• Preferred: CCM
• Years of experience required: 5 years or more experience with adults. A home care RN historically does well in this position
• Comfortable with cold calls and able to pivot in different directions to work with each member with compassion and empathy.
• Highly organized
• The ability to prioritize and change priorities on a daily basis for the member and as needed for team and business needs.

Position Purpose:

• Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

Education/Experience:

• Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 - 6 years of related experience.

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Responsibilities

• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
• Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the

member's goals / unmet needs

• May identify problems/barriers for care management and appropriate care management interventions for escalated cases
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Reviews referrals information and intake assessments to develop appropriate care plans/service plans
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness ?
• Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice?
• Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
• Other duties or responsibilities as assigned by people leader to meet business needs
• Performs other duties as assigned
• Complies with all policies and standards

Interested candidates please send resume in Word format Please reference job code 247760 when responding to this ad.