RN Care Manager

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

📋 Description

• Coordinate services for members who meet specified criteria.

• Educate members while promoting self-management, quality care, and cost-effective results.

• Evaluate member needs, review available services and resources, and create as well as implement personalized care plans.

• Organize resources, track progress, assess member status, and discharge members when criteria are fulfilled.

• Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs.

• Offer counseling and referrals to community, local, state, and other programs.

• Collaborate with caregivers, providers, community agencies, behavioral health teams, and other available resources.

• Manage and oversee a caseload of members who are moderate- to high-risk with complex needs.

• Act as a liaison among participants, families, physicians, and treatment team members.

• Establish prioritized goals and health actions that promote self-directed care and improved health outcomes.

• Advocate for members and families by coordinating care and assisting in navigating resources.

• Analyze referrals and perform assessments to ascertain enrollment, acuity, functional status, psychosocial status, and barriers.

• Secure necessary consent forms.

• Conduct and record care management activities in compliance with policies and procedures.

• Cultivate relationships and implement interventions that support member stabilization, knowledge enhancement, self-management, and long-term care outcomes.

• Identify and report quality-of-care issues.

• Uphold member confidentiality.

• Participate in mandatory company and departmental meetings and training sessions.

⛳️ Requirements

• Minimum of three (3) years of recent and relevant experience.

• Registered Nurse with an active license in the home state.

• Additional state licensure as required to meet client needs.

• Certification in Case Management within 2 years of employment.

• Preferred experience in care management, home health, medical/surgical behavioral health, and/or critical care.

• Preferred experience in health plans.

• Experience with health coaching and motivational interviewing techniques is preferred.

• Strong communication, clinical process, critical thinking, and problem-solving abilities.

• Exceptional written, oral communication, listening, and organizational skills.

• Capability to use a computer system while conversing over the phone.

• Proficient in Microsoft Office.

• Knowledge of NCQA, DMAA, CMSA, Act 68, CMS, and ERISA standards.

• Familiarity with evidence-based guidelines for chronic conditions and care management.

• Understanding of clinical and managed care principles and operations.

• Knowledge of current and emerging medical treatment modalities and best practice guidelines.

• Awareness of adult learning principles, motivational interviewing, and intrinsic coaching techniques.

• Ability to prioritize tasks effectively and complete responsibilities accurately and promptly.

• Capacity to work independently and as part of a multidisciplinary team.

• Willingness to travel to provider, facility, employer group, and/or member locations using personal vehicle, if necessary.

🏝️ Benefits

• Coverage for Medical, Dental & Vision.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Flexible working environment.

• Training and continuing education opportunities.

• Chances to volunteer in the community.