Registered Nurse, Care Manager

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

📋 Description

• Carry out case management functions in alignment with Veracity Benefits policies and procedures.

• Oversee intricate, acute cases to guarantee high-quality, cost-efficient healthcare services and optimal health outcomes.

• Organize and facilitate member care through assessment, evaluation, planning, and implementation via telephonic case management activities.

• Relay member requirements to care team members and ensure appropriate follow-up.

• Support discharge planning as required.

• Collaborate with members, their families, physicians, and other care team members.

• Offer education and assistance in managing conditions and symptoms.

• Guide members in navigating the healthcare system and comprehending plan benefits and resources available.

• Coordinate access to healthcare providers, community resources, and health benefits.

• Implement interventions to prevent adverse health outcomes, minimize readmissions and unnecessary treatments, manage transitions of care, and enhance wellness.

• Maintain consistent communication with members and care team members.

• Document case management activities, medical record reviews, communications, service coordination, resource linking, advocacy, education, and negotiations.

• Assess and summarize member health status, prognosis, treatment plans, and anticipated costs.

• Research and provide cost-saving resources including alternative funding programs, manufacturer assistance, and grants.

• Advocate for the appropriate level of care while addressing barriers and psychosocial issues.

• Develop care plans comprising interventions and anticipated cost savings.

• Report patient safety concerns to the Medical Director, Physician Advisor, or leadership.

• Engage in clinical rounds, staff meetings, and committee meetings.

• Provide insights on care management program services, procedures, and resource requirements.

• Advocate for access to quality, cost-effective care and treatment objectives.

• Negotiate discounts or reduced fees with high-cost or out-of-network providers.

• Uphold HIPAA confidentiality.

• Coordinate with stop-loss/reinsurance carriers regarding health status, prognosis, and expected costs for employer group renewals.

⛳️ Requirements

• Registered Nurse with a clear, active, and unrestricted license in the state of residence.

• Multi-state Compact RN license preferred (mandatory upon hire).

• A Bachelor's degree (or higher) in a health-related discipline.

• Certification in Case Management (CCM) or equivalent preferred (to be obtained within one year of hire).

• At least five (5) years of direct patient care experience in an acute care or hospital-based environment.

• Three (3) to five (5) years of case management or similar experience.

• Experience in a managed care setting is preferred.

• Strong problem-solving skills are crucial.

• Excellent typing, computer, and documentation abilities.

• Capability to coordinate and communicate effectively with a multidisciplinary team (both internal and external).

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on team collaboration.

• Competitive salary and performance-based incentives.