Care Manager RN

Job Description:

Job Tittle: Care Manager (RN)

Location: Remote

Duration: 2 Months (Possible Extensions)

Shift: 8AM 5PM (MonFri)

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.

Walk me through the daytoday responsibilities of this the role and a description of the project:

• 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 member 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.

Describe the performance expectations/metrics for this individual and their team:

• CM caseload expectation is 75 actively managed members Audit score of 90%or greater Case duration 90 days.

Tell me about what their first day looks like:

• The first day is usually corporate HR training setting up company issued equipment and access necessary to perform role specific duties.

What previous job titles or background work will in this role

• RN experience in case management preferred clinical nursing background of 5 years or more.

Licenses/Certifications:

• Current states RN license.

Responsibilities:

• Assess the members current health status resource utilization past and present treatment plan and services prognosis short and longterm 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 members needs and promote desired outcomes.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased 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.