Job Description

Current and Active RN license

Summary:
Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.
Works with members to create and implement an integrated collaborative plan of care.
Coordinates and monitors members progress and services to ensure consistent cost effective care that complies with and all state and federal regulations and guidelines.

Essential Functions:
Provides case management services to members with chronic or complex conditions including:
Proactively identifies members that may qualify for potential case management services.
Conducts assessment of member needs by collecting in-depth information information system, the member, members family/caregiver, hospital staff, physicians and other providers.
Identifies, assesses and manages members per established criteria.
Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
Measures the effectiveness of interventions to determine case management outcomes.
Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members.
Conducts face to face or home visits as required.
Maintains department productivity and quality measures.
Manages and completes assigned work plan objectives and projects in a timely manner.
Demonstrates dependability and reliability.
Maintains effective team member relations.
Adheres to all documentation guidelines.
Attends regular staff meetings.
Participates in Interdisciplinary Care Team (ICT) meetings. Familiarity with NCQA standards, state/federal regulations and measurement techniques.
Able to maintain regular attendance based upon agreed schedule.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Education: Bachelor's degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience: 5-7 years of clinical experience with case management experience.

Required Licensure/Certification: Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing. A combination of experience and education will be considered in lieu of LCSW or APSW. Must have a valid driver's license with a good driving record and be able to drive locally.

Job Tags

Remote job,

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