Care Manager RN - 707 and 708

This is a work form home contracted position for 3/4 months.

ESSENTIAL RESPONSIBILITIES

· Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.

· For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.

· Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.

· Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.

· Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.

· Other duties as assigned or requested.

Required Qualifications:

• Educational requirements: High School Diploma/GED
• Professional experience, skills and qualifications:
  • 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
  • RN license in DE.
  • Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
  • Broad knowledge of disease processes
  • Understanding of healthcare costs and the broader healthcare service delivery system
  • Proficiency in MS Excel and computer skills.
  • Strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
  • Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
  • Ability to work in a high performing team environment that requires flexibility
  • Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management, problem solving, and project management skills
  • Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Preferred Qualifications:

• Educational requirements: Bachelor’s Degree in Nursing
• Professional experience, skills and qualifications:
  • Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
  • Experience working with the healthcare needs of diverse populations
  • Understanding of the importance of cultural competency in addressing targeted populations
  • Experience working at either Quantum or Accolade
  • Certification in Case Management