Remote Utilization Review Rn Jobs in Canton, OH (NOW HIRING)

About Us
A pioneer in the caregiving space, Careforth supports family caregivers across the United States to confidently care for their loved ones at home. Through a combination of in-person home visits, remote coaching and our proprietary digital collaboration app, we provide caregivers with support, guidance, confidence, and connection to resources they need. The Caregivers and families we support stay with Careforth for many years, building lasting relationships along the way. Join us today and live our values: lead with heart, cultivate trust, go beyond.
Position Summary
Reporting to the Manager, Care Management, the Care Management Lead (CML) is responsible for supporting the clinical quality and compliance of care management services. The CML is the lead escalation point for clinical issue management and support. The CML works with teams to ensure compliance with documentation standards, required regulations, and best practices. The CML will collaborate with the Manager, Care Management and consult with additional clinical and compliance resources to ensure the effective onboarding and ongoing clinical support of care management teams to ensure delivery of high-quality services to consumers and caregivers. The CML creates and maintains a person-centered business culture that fosters commitment, continuous improvement, employee and caregiver engagement, and high performance.
What You Will Do

• Respond to requests from caregivers and consumers and communicate with team members regarding concerns or emerging issues
• Track consumer risk and work with care teams to adjust the plan of care (POC) as appropriate
• Manage the case conference process, facilitating case review as well as discussion of risk mitigation strategies and follow-up
• Resolve and respond to complaints or grievances expressed by consumers or caregivers or their stakeholders
• Drive effective utilization of established best practices and protocols across the team, ensuring compliance with contractual obligations and NCQA accreditation requirements; observe virtual/home visits with care management team members and review documentation for quality
• Coach and mentor care team members and identify individual or team training needs; provide training to new clinical team members and others as needed
• Assist the Manager, Care Management with incident investigations and reporting
• Ensure continuous survey and audit readiness, maintaining compliance with company policies and practices as well as federal/state/local regulations
• May supervise administrative staff
• Perform other projects and duties as assigned

What You Will Bring

• Bachelor's degree or equivalent, preferably in a health care or social services discipline is required along with a minimum of 4-6 years of experience in case management and care planning for older adults with complex medical conditions and/or individuals with disabilities, preferably in a health care, long-term care, social service or community setting.
• Must hold an active Registered Nurse (RN) License and/or be a Licensed Social Worker (LSW/LISW) in the state of Ohio
• Demonstrated ability to coach and mentor others
• Working knowledge of case management systems, community service and delivery systems, and Microsoft Office suite
• Ability to travel (usually by automobile) within assigned geographic area; valid driver's license and automobile insurance is required
• Additional state-specific qualifications may be required

You'll Benefit From
At Careforth your well-being matters. With flexible schedules, a remote-first culture, and a nationally recognized wellness program, our benefits are designed to help you thrive, both professionally and personally. Discover how we invest in you: https://careforth.com/careers/#benefits
The pay range for this position is $68,700 - $84,200. The actual wage offered may be lower or higher depending on budget and candidate experience, knowledge, skills, qualifications, and geographic location.
#LI-Remote (Role is remote; for Akron, OH only)
Join Our Award Winning Team
Founded in Boston, Careforth's caregiver programs and services improve health outcomes, keeping care at home longer. Additionally, our programs provide financial benefit to caregivers and cost savings to state agencies and health plans. At Careforth, we understand the challenges of caregiving and are committed to supporting family caregivers at every turn.
Caregivers play a critical role in the future of healthcare-and so can you.
Apply now!
For more information, please visit www.Careforth.com.
Careforth is an Equal Opportunity Employer*
DISCLAIMER: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.
*Careforth supports families with diverse backgrounds and as an equal opportunity employer, we seek employees who reflect the diverse population we serve. Careforth complies with all applicable laws concerning hiring and employment practices and is firmly committed to fostering and maintaining a workplace free from discrimination. We pledge to hire, train, and promote our employees without regard to race, religion, gender, gender identity, genetic information, age, national origin, sexual orientation, disability, veteran status, or any other category protected by applicable law.
Careforth strives to create experiences that are accessible and welcoming to everyone, including making www.careforth.com and the careers site accessible to any and all users. If you would like to contact us regarding the company's diversity, equity and inclusion initiatives, inquire about a specific accessibility need or the accessibility of our website, or if you need assistance completing an application process, please contact People & Culture at 866-797-2333.