RN Care Manager

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

📋 Description

• Oversee services for members who meet specified criteria.

• Inform members, encourage self-management, ensure quality care, and achieve cost-effective results.

• Evaluate member requirements, explore service and resource alternatives, and create and execute care plans.

• Coordinate resources, track progress, assess member condition, discharge members, and document care management activities and results.

• Address needs related to medical, psychosocial, clinical, behavioral health, mental health, and substance use disorders.

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

• Collaborate with caregivers, providers, community organizations, behavioral health teams, and additional resources.

• Manage a caseload of moderate- to high-risk members with intricate needs.

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

• Create prioritized objectives and health actions that support self-directed care and enhance health outcomes.

• Advocate for members and their families, assisting in care coordination and resource navigation.

• Analyze referrals and evaluate candidates for enrollment based on set criteria.

• Secure necessary consent forms.

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

• Conduct activities in accordance with departmental and corporate policies and procedures.

• Foster relationships with members and their families while implementing interventions aimed at enhancing knowledge, self-management, and long-term results.

• Identify and report issues related to quality of care.

• Uphold member confidentiality.

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

⛳️ Requirements

• Registered Nurse with active licensure in the home state.

• Additional state licensure as required to meet client needs.

• Certification in Case Management within two years of employment.

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

• Understanding of NCQA standards for Population Health Management, DMAA standards, CMSA Standards of Practice, Act 68, CMS, and ERISA.

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

• Knowledge of clinical and managed care principles and operations.

• Awareness of current and emerging medical treatment methods and best practice guidelines.

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

• Proficiency in Microsoft Office Suite.

• Excellent communication, clinical process, critical thinking, problem-solving, written, oral, listening, organizational, and customer service skills.

• Ability to prioritize tasks, complete responsibilities accurately and promptly, work independently, and within an interdisciplinary team.

• Capability to operate a computer system while engaging in telephone conversations.

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

🏝️ Benefits

• Medical, Dental & Vision coverage.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Training and continuing education.

• Flexible work environment.

• Community volunteering opportunities.