Care Manager, Registered Nurse

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

📋 Description

• Engage in telephone conversations with members, caregivers, and providers to create a thorough care plan, pinpoint essential strategic interventions, and cater to the members’ needs at various points along the care continuum.

• Act as an integral part of the care team by collaborating with primary care physicians, specialists, other healthcare professionals, and members to achieve healthcare objectives through the creation and execution of Care Plans.

• Evaluate the member’s ongoing care requirements and their progress towards goals throughout the duration of the plan, making adjustments as necessary to accommodate changes in the member’s condition, lack of progress towards care plan goals, shifts in preferences, and transitions between care settings.

• Coordinate the care plan with objectives aimed at member stabilization, reduction of admissions, medication management, behavior modification, and self-management capabilities.

• Organize patient education in alignment with care standards and related health concerns, using the most suitable methods for each member.

• Identify pertinent benefit and community resources, assess Social Determinants of Health, and facilitate referrals according to member needs.

• Assist the member in coordinating any necessary tests, imaging, and consultations with specialists.

• Conduct medication reconciliation at the initiation of the care plan, following any health status changes, and every thirty days throughout the care plan's duration, evaluating efficacy and potential drug interactions or side effects.

• Facilitate and oversee the transition of care, which entails moving the member from one healthcare provider to another as their healthcare requirements evolve.

• Implement and supervise the agreed-upon care plan, as well as coordinate member follow-up after discharge.

• Adhere to established documentation standards to ensure quality care plan documentation, which includes tracking member progress towards their defined health status and identifying barriers to achieving care plan goals and outcomes.

• Comply with the Value-Based Care Management Program Description and Guidelines.

• Achieve productivity and quality metrics as specified by leadership for each year.

• Complete all mandatory training and annual competency assessments.

• Actively participate in team huddles and contribute to clinical education.

• Stay updated on clinical knowledge through self-directed learning.

⛳️ Requirements

• A current multi-state compact Registered Nurse license in the state of residence is required, with the ability to obtain additional licenses without restrictions.

• A Bachelor of Science in Nursing (BSN) is preferred.

• Experience in motivational interviewing is preferred.

• A minimum of 3-5 years of diverse clinical experience with strong preference for telephonic Case Management experience.

• Demonstrated computer proficiency, including electronic medical records, word processing, spreadsheets, and presentation preparation.

• Proven ability to learn specialized computer applications.

• Proficient in utilizing all technology, including Microsoft Teams, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, and other relevant unified communication technologies.

🏝️ Benefits

• A comprehensive benefits package