Health Plan Care Manager

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

📋 Description

• Deliver comprehensive, person-centered care management interventions for enrolled members and their families.

• Engage, assess, monitor, educate, coordinate, and implement interventions to enhance care quality and health outcomes.

• Minimize unnecessary healthcare and hospital utilization.

• Conduct thorough advanced-level nursing assessments, including targeted physical examinations.

• Utilize evidence-based standards, criteria, and HEDIS quality measures.

• Manage care in alignment with benefits structures and adhere to compliance, contractual, and accreditation regulations.

• Complete timely member assessments, screenings, care transition assessments, encounters, and follow-ups.

• Document assessments, encounters, and activities in the case management medical record accurately.

• Collaborate with primary care providers, specialists, medical directors, hospitals, skilled nursing facilities, home health providers, community agencies, members, families, and caregivers.

• Address medical, health, social, psychological, environmental, and lifestyle concerns.

• Develop and present case studies; engage in clinical rounds, in-services, staff education, and training sessions.

• Exhibit respectful, professional, ethical conduct and outstanding customer service.

• Contribute to process improvements and quality initiatives.

• Provide project support and fulfill additional assignments as necessary.

⛳️ Requirements

• Bachelor’s degree in nursing is mandatory.

• 5 years of contemporary clinical experience is required.

• Experience in medical-surgical, home care, hospice, community health, rehabilitation, long-term care, cardiovascular, diabetes, renal, pulmonary diseases, oncology, or geriatrics.

• Background in a managed care, home health, or hospital setting is essential.

• An unrestricted state licensed registered nurse license is required.

• Familiarity with the Scope of Nursing Practice in states where licensed is necessary.

• Current clinical expertise in chronic diseases, heart disease, COPD, diabetes, renal disease, and additional co-morbidities.

• Must be a self-starter with high energy, productivity, and a strong work ethic.

• Proven ability to work effectively as part of a team.

• Flexibility and adaptability in managing multiple priorities and adjusting to changing schedules.

• Strong written and verbal communication skills are essential.

• Excellent organizational and time management capabilities are required.

• U.S. citizenship verification is mandatory.

• Employment eligibility verification must be completed upon hire.

• This position does not qualify for immigration sponsorship.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings plan with employer contributions.

• Paid time off.

• Volunteer time off.

• Pie day.

• Additional employee benefits.