Overview

Under the direction of the Supervisory Care Manager, the RN Care Manager (CM) is responsible for providing comprehensive care coordination services to enrollees with high-complexity medical and behavioral needs. This CM will have a caseload of medically fragile enrollees focusing on medical intervention and associated care coordination needs outlined by the enrollee assigned acuity level. The CM routinely communicates with enrollees on their assigned caseload to assess their needs; develop, monitor, and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for enrollees with highly complex medical and psychosocial needs.

Responsibilities

Manages a caseload as outlined by CASSIP and Care Management Leadership.
Maintains compliance in accordance with contractual and care management requirements
Assists in research, and implementation of disease management/population health programs to serve our highest complexity members.
Conducts outreach and face-to-face visits at a frequency no less than determined by the enrollee’s assigned acuity level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations.
Assesses enrollees on enrollment and at intervals no less than determined by the enrollee’s acuity level to identify needs/barriers and close gaps in care.
Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.
Gathers physical and mental/behavioral health, environmental, psychosocial, and educational information; the CM develops, implements, and updates an accurate, individualized comprehensive care plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members, including public agencies.

Qualifications

Current licensure as a Registered Nurse (RN) with active state registration.
Proven experience in critical care settings such as ICU or Level I/II trauma centers; experience in emergency medicine or hospital medicine is highly desirable.
Strong background in medical-surgical nursing, post-acute care, or outpatient clinic environments.
Knowledge of physiology principles relevant to acute and chronic conditions across diverse populations including pediatrics and geriatrics.
Familiarity with managed care processes, utilization management protocols, and discharge planning procedures.
Proficiency in medical terminology, diagnostic evaluation techniques, and medical records documentation.
Excellent patient assessment skills combined with effective communication abilities for diverse audiences.
Ability to navigate hospital systems efficiently while maintaining attention to detail in documentation.
Experience working within HIPAA guidelines ensuring confidentiality of protected health information. Join our team as a Registered Nurse Care Manager to make a meaningful difference in patients' lives through expert coordination of complex healthcare needs. Your dedication will foster improved health outcomes while advancing your professional growth within a supportive environment committed to excellence.

Minimum Education
- Associate's Degree in Nursing (Required)
- Bachelor's Degree in Nursing (Preferred)

Minimum Work Experience
- 2 years Clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or Managed Care (Required)
- 1 year Working in a Public/community health setting. (Required)

Required Skills/Knowledge
- Must have an advanced knowledge of clinical standards of care and disease processes.
- Must have excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for enrollees. Spanish Speaking preferred
- Must be able to provide excellent internal and external customer service.
- Must be proficient in the knowledge of available community resources and programs and - Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.
- Must have the ability to produce accurate and comprehensive work products with minimal direction.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external stakeholders within set expectations for service excellence.
- Must have a basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).

To Apply download our app 360X JOBS, visit our website www.360xstaffing.com and click "Join our Team."

Pay: $100,000.00 - $115,000.00 per year

Work Location: In person

360X Staffing

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