Care Manager – Registered Nurse

Description

 

FLSA Status	Exempt	Salary Range	$80,000-110,000
Reports To	Medical Management Director	Direct Reports	Yes
Location	Remote	Travel	Up to 10%
Work Type	Regular	Schedule	Full Time

• Evaluates patients for care management services, determines appropriate level of care coordination management for the patient 
• Complete a comprehensive assessment to identify patient risk and develop a care plan utilizing clinical expertise and judgement to evaluate needs for alternative services as needed 
• Work collaboratively with physicians and in-house resources including pharmacists, registered dieticians, social workers and other disciplines to create a person-centered care plan with measurable SMART goals 
• Monitor and update care plan to include progress towards achieving established goals and self-management activities 
• Interact with patient, family and providers and multidisciplinary care team to assess the options of care including use of benefits ad community resources to update care plan. Utilize developed systems, processes, and initiatives to engage patients in relevant case management activities necessary to promote wellness and care at the right place and time.
• Work collaboratively with physicians and in-house resources including pharmacists, registered dieticians, social workers and other disciplines to support patient adherence to medical plan of care.  
• Supervise and act as a resource for non-clinical staff [i.e. care coordinators, social workers].
• Verify that appropriate home care, hospice care, and other ancillary services (DME, infusion services etc.) are in place and are being delivered as directed by the care team
• Coordinate necessary referrals and authorizations within care management areas
• Facilitate the information flow between hospital, long-term care, specialists and home health representatives and the care team
• Use available data and work with physician and office staff to help identify high risk, high need, and potentially high-cost patients
• Coordinate care and communicate with multiple providers, internal and external to the practice.
• Identify and utilize cultural and community resources and align with the patient’s cultural preferences as much as possible
• Verify that members are screened for behavioral health concerns (depression / substance abuse) and are receiving appropriate screening and behavioral health interventions.
• Facilitate any necessary follow-up behavioral health needs with local behavioral health providers.
• Attend required training and collaboration sessions [i.e., learning sessions, care management meetings, and practice team meetings] as scheduled.
• Provide and facilitate open communication, regarding patient status, with physicians and office staff.
• Obtain records from other physicians/labs/diagnostic centers as requested by the physicians and as needed for care coordination efforts.
• Develop constructive relationships with internal population health team members, participating providers, and community resources.
• Other job-related duties as assigned

• Compact RN License – California and NY Licensure preferred in addition
• Bachelor’s degree in nursing preferred; Associate degree in nursing is minimum requirement.
• 1-2 years’ experience in acute inpatient, rehabilitation, sub-acute, skilled facility, home care, ambulatory care management, or managed health plan.
• Preferred: Certified Case Management (CCM) certification
• Preferred: Care/Case Management experience

• Principles of utilization management; care management principles; basic knowledge of health plan contracts and benefit eligibility requirements; Hospital structures, Managed Care and payment systems
• Timely and accurate documentation of day-to-day activities in designated technology platform
• Adaptable to new technologies and software
• Proficiency in EMR system(s), Outlook and data entry experience preferred
• Basic PC skills (MS Word/Outlook/PPT/Excel)

• Ability to use independent judgment and to manage and impart confidential information.
• Ability to analyze and solve problems; requires details, data and facts that must be analyzed and challenged prior to making decisions.
• Strong communication and interpersonal skills.
• Ability to clearly communicate medical information to professional practitioners and/or the public.

• Excellent organization, prioritization, follow up, analytical and time management skills with ability to handle multiple priorities and deadlines.
• Good interpersonal skills, sense of urgency, being proactive and ownership for one’s work.
• Dependable, with strong work ethic and extremely high degree personal integrity.
• Ability to deal with multiple interruptions on a continual basis that must be met with a friendly exchange with others.
• Ability to develop and implement new approaches to improve processes, procedures, or the general work environment.
• Ability to review critical issues, effectively solve problems and create action plans.

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