Care Manager (RN)

Position Title: Care Manager RN

Work Location: Remote-US (candidates from CA not accepted)

Assignment Duration: 6 months (possibility to extend or convert)

Work Schedule: 9:30 AM - 6:00 PM EST

Position Summary: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Background & Context:

• Project Ascend hiring to facilitate ScriptMed cloud (a new Operating System) training and implementation.

• Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome.
• Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs.
• Identifies problems/barriers to care and provide appropriate care management interventions.
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
• Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
• Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate.
• Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services.
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Other duties or responsibilities as assigned by people leader to meet business needs.
• Performs other duties as assigned.
• Complies with all policies and standards.

• Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 - 4 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• Must haves: 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
• Knowledge of utilization management principles and healthcare managed care.
• Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
• Nice to haves: Strong communication skills, Proficient technology skills.
• Performance indicators: Must be able to manage daily tasks with a high quality of work. Goals will be given to the candidate to help them work towards the department's expectations for success.