RN Care Manager

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

📋 Description

• Coordinate services for members who fulfill established criteria.

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

• Assess member needs and evaluate service and resource options.

• Develop and implement personalized care plans.

• Coordinate resources and track member progress.

• Evaluate member status and discharge members when criteria are satisfied.

• Document the individualized member care management process and outcomes.

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

• Provide counseling and referrals to community, local, and state programs.

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

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

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

• Analyze and evaluate referrals for potential program enrollment.

• Conduct assessments to ascertain acuity, functional status, psychosocial status, and barriers.

• Obtain necessary consent forms.

• Apply discharge criteria and discharge members from care management programs.

• Identify and report quality-of-care issues.

• Uphold member confidentiality.

• Attend company and departmental meetings as well as training sessions.

⛳️ Requirements

• Registered Nurse with active licensure in the home state.

• Additional state licensure as required to meet customer needs.

• Certified Case Management certification must be obtained within 2 years of employment.

• Minimum of three (3) years of recent/related experience.

• Familiarity with NCQA standards for Population Health Management.

• Knowledge of DMAA standards for disease management.

• Understanding of CMSA Standards of Practice for Case Management.

• Knowledge of Act 68, CMS, and ERISA.

• Awareness of evidence-based guidelines for chronic conditions and care management.

• Knowledge of clinical and managed care principles and operations.

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

• Familiarity with adult learning principles, motivational interviewing, and intrinsic coaching techniques.

• Proficiency in Microsoft Office Products.

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

• Ability to work independently and as part of an interdisciplinary team.

• Compact RN license is preferred.

• Experience in care management, home health, medical/surgical behavioral health, and/or critical care is preferred.

• Health plan experience is preferred.

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

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Flexible work environment.

• Training and continuing education.

• Community volunteering opportunities.