Care Manager
Job Tittle: Care Manager (RN)
Location: Remote
Duration: 2 Months (Possible Extensions)
Shift: 8AM – 5PM (Mon-Fri)
Position Purpose
Location: Remote
Duration: 2 Months (Possible Extensions)
Shift: 8AM – 5PM (Mon-Fri)
Position Purpose
- Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
- Remote telephonic case management, Care manager (CM) follows model of care to assist member in managing health care needs.
- Conducts initial assessments, medication review, develops care plan with members, identifies member needs and connects member with appropriate resources to meet health care needs.
- Interacts with members care team, community services, vendors.
- Follows up with member every 30 days at minimum to review conditions, progress toward goals, and ensure member is receiving requested information and/or services.
- Provides education on member health plan and coverage and management of identified health conditions.
- CM caseload expectation is seventy-five actively managed members, Audit score of 90%or greater, Case duration 90 days.
- The first day is usually corporate HR training, setting up company issued equipment and access necessary to perform role specific duties.
- RN, experience in case management preferred, clinical nursing background of 5 years or more.
- Licenses/Certifications:
- Current state’s RN license.
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options.
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes.
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
- Provide patient and provider education.
- Facilitate members’ access to community-based services.
- Monitor referrals made to community-based organizations, medical care, and other services to support the members’ overall care management plan.
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience.
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
- Direct care to participating network providers.
- Perform duties independently, demonstrating advanced understanding of complex care management principles.
- Participate in case management committees and work on special projects related to case management as needed.
- For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required.
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Seniority level
Mid-Senior level -
Employment type
Full-time -
Job function
Health Care Provider -
Industries
Staffing and Recruiting
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