Care Manager

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Develop, implement, and manage care plans for members with recognized care management needs.

• Support the creation, maintenance, and monitoring of processes for the prompt identification and assessment of high-risk and special-needs members.

• Act as a member of an interdisciplinary team in the management of identified members.

• Conduct clinical and social determinants of health assessments.

• Collaborate with physicians to assess medical requirements.

• Carry out telephone or in-person interviews with members to identify risk factors and care management requirements.

• Build professional networks with service and resource providers.

• Initiate, develop, plan, and execute care plans that promote quality care and service.

• Discharge members from care management in accordance with established policies and procedures.

• Maintain care management documentation and ensure data integrity within health plan information systems.

• Gather, assess, and report clinical, functional, and program activity data.

• Identify cases for evaluating the effectiveness of care management services and assist in data collection.

• Educate members' medical providers regarding their special needs.

• Coordinate and communicate with community support and social service systems.

• Lower care costs through effective service coordination and collaboration across disciplines.

• Work with multidisciplinary teams to enhance member care and eliminate barriers.

• Assist in formulating care management policies and procedures.

• Communicate updates on departmental, member, program status, and compliance matters to the supervisor/manager.

• Uphold patient confidentiality and adhere to medical information release protocols.

• Identify and report deficiencies in the service delivery system.

• Foster positive working relationships with other departments.

⛳️ Requirements

• Must be a graduate of an accredited nursing school.

• Must hold a current, unrestricted Registered Nurse license to practice in Maryland.

• At least 2 years of clinical nursing experience in an acute care or community setting.

• Minimum of 2 years of experience in Care Management.

• Experience aiding members in accessing community agencies and resources.

• Proficient computer and keyboarding skills.

• Familiarity with Microsoft Office 365 and common computer and office equipment.

• Understanding of remote work tools and platforms, including Microsoft Teams, Zoom, and SharePoint.

• Ability to perform mathematical skills and statistical calculations accurately.

• Proven written and verbal communication skills.

• Capability to deliver presentations and training to both small and large audiences.

• Knowledge of the Americans with Disabilities Act of 1990.

• Strong problem-solving, organizational, and time management capabilities.

• Ability to consistently thrive in a fast-paced environment.

• Familiarity with government-sponsored managed care programs is preferred.

• BSN is preferred.

• CCM certification is preferred.

• Ability to adhere to HIPAA guidelines and maintain the confidentiality of patient information.

🏝️ Benefits

• Medical, dental, and vision insurance plans.

• 100% employer-provided Term Life Insurance.

• Short-Term and Long-Term Disability coverage.

• 401k plan with employer match up to 4%.

• 20 days of Paid Time Off (PTO).

• Tuition assistance and professional development programs.

• Various work arrangements available.

• Opportunities for organizational-wide social engagement.

• Initiatives focused on Diversity, Equity, and Inclusion.