Nurse Case Manager II

•*Please list candidates state at top of resume - candidate must reside in an EST time zone and must work EST hours**



•*PUT ON RESUME***

Registered Nurse with active state license in good standing within the region where job duties are performed is required.

Must be license in state of PA

If residing in a compact licensure state, it is preferred that RN license is part of the compact. - MUST HAVE A COMPACT LICENSE IF THE CANDIDATE DO NOT RESIDE IN PA



•* Set Class Start of 10/13**



SAFETY



Program Overview



Help us elevate our patient care to a whole new level! Join our Healthcare team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan(DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.



Position Summary/Mission



Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member s overall wellness.



Position Summary:



Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member s overall wellness.



Requires an RN with unrestricted active license



Duties:



Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member s overall wellness.

Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.

Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.

Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.

Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.

Collaborates with supervisor and other key stakeholders in the member s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences

Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.



Experience:



Minimum 3-5 years clinical practical experience

Minimum 2-3 years CM, discharge planning and/or home health care coordination experience

Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually

Bilingual desired

Excellent analytical and problem-solving skills

Effective communications, organizational, and interpersonal skills.

Ability to work independently

Effective computer skills including navigating multiple systems and keyboarding

Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications



Education:



Registered Nurse with active state license in good standing within the region where job duties are performed is required.

Must be license in state of PA

If residing in a compact licensure state, it is preferred that RN license is part of the compact.

Additional state licenses preferred.

Certified Case Manager is preferred.