Role: RN (Registered Nurse) Case Manager
Location: Remote
Duration: 12 months
Description:
- The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs.
- They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the Client online messaging platform.
- The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum.
- They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.
Essential Duties and Responsibilities:
- Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally.
- The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors.
- Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum.
- Assess the member's health, psychosocial needs, cultural preferences, and support systems.
- Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes.
- Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).
- Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family.
- Advocate for members and promote self-advocacy.
- Deliver education to include health literacy, self-management skills, medication plans, and nutrition.
- Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary.
- Accurately document interactions that support management of the member.
- Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
- Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
- Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
- Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals.
- Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).
Education and Experience
- Nursing Diploma or Associates degree in nursing required.
- Bachelor’s degree in nursing strongly preferred.
- 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
- 1 year of case management experience in a managed care setting strongly preferred.
- Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.
Certificates, Licenses, Registrations
- Current, active, and unrestricted Multistate Compact Registered Nurse license required
- Certification in Chronic Care Professional (CCP) and Certification in Case Management (CCM)
Qualifications
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
- The requirements listed below are representative of the knowledge, skill, and/or ability required.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member’s outcomes.
- Empathetic, supportive and a good listener.
- Proficient in motivational interviewing skills.
- Demonstrated time management skills.
- Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member.
- Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
- Must embrace teamwork but can also work independently.
- Excellent interpersonal and communication skills both written and verbal.
- Additional experience:
- Maternity, NICU, Mother/Baby, and/or Labor and Delivery experience that also carries a Multistate nursing compact license.
