RN Case Manager

The RN Case Manager is primarily responsible for the daily management and
support of the Case Management strategies for care coordination for a group of
members who are associated with a Medicare Advantage plan. Visit (in person
and/or telephonic) patients to ensure proper nursing care. Interview or
correspond with physicians to correct errors or omissions and to investigate
questionable claims. Consult and coordinate with health care team members to
assess, plan, implement and evaluate patient care plans.

This position requires an individual who is a self-starter and team player, has
the ability to manage multiple priorities, work with minimal supervision on
assigned projects and activities, and demonstrates excellent communication and
presentation skills. This individual must be able to adapt quickly to change and
be able to collaborate with multiple teams

Here are a few of our benefits

* Annual performance wage increases
* 401k retirement plan with a company match
* Medical, dental and vision insurance
* $50,000 basic life insurance – paid by the company
* Paid time off
* UKG Wallet – access your pay faster!
* Holiday pay
* Telehealth through 98point6 – free to all employees
* Continuing Education opportunities
* Career Advancement Opportunities

Qualifications/Requirements

* Minimum of 2 years of experience in clinical nursing or rehabilitation for
the geriatric population.
* 2-years managed care experience required.
* Minimum of 3-5 years’ experience doing case management in a managed care
environment preferably with a managed care organization or like facility,
Preferred.

Essential Functions

* Complete Health Risk Assessments for members as assigned.
* Initiate, update and/or revise care plans as needed.
* Maintain a case load of patient as assigned.
* Evaluates, coordinates, and plans patient care in collaboration with an
interdisciplinary health team; reassesses and revises plans of care in
collaboration with other members of the health care team.
* Provides patient/family education based on identified learning needs
utilizing available teaching resources
* Provides education based on identified learning needs utilizing available
teaching resources to members of the Home/Facility staff as needed.
* Coordinates outpatient discharge planning based on patient needs, clinical
circumstances and benefit coverage.
* Participates in all Managed Care related audits; generates, maintains and
tracks periodic and annual reports/documents via MS Office program, e-mails
to support Care Coordination program.
* Performs improvement projects involving development of monitoring/collection
tools, review of medical records, data entry, analysis, and preparation of
audit findings and reports.
* Participates in patient care conferences, committee meetings, staff
development and educational programs to increase or maintain professional
competency.
* Correctly applies medical management criteria.
* Researches clinical questions from employers, members and payers as required.
* Educate members on health access options.
* Responds, manages, and resolves day-to-day problems presented in care
coordination and communicates effectively with the Facility/Home.
* Other duties as assigned.

Education

* Graduate of an accredited RN program.
* Bachelor’s Degree preferred.

Licensure/Certifications

* Current license to practice as a register nurse in assigned state.
* Current CCM license, Preferred
* CPR for Healthcare Professionals certification.
* Current valid driver’s license.
* Current motor vehicle insurance.