[Hiring] Case Manager RN @Emergent Holdings

Role Description

The telephonic RN Case Manager position is responsible for utilizing the nursing process in the development of member treatment plans. The Case Manager will establish member goals and implement interventions to optimize member health care across an assigned patient caseload in order to promote high quality healthcare appropriate for the member’s clinical needs.

• Improve member health outcomes by successfully managing a member caseload from a variety of care management referral sources.
• Conduct telephonic member assessments to identify member care coordination needs.
• Develop, with member and provider as appropriate, a specific care management plan to address member goals and interventions as identified during assessments.
• Manage members with chronic illness, co-morbidities, and/or complex health conditions.
• Provide member and/or caregiver self-management strategies and ensure member receives appropriate level of post-care education.
• Identify potential gaps in member care through education, empowerment, and/or motivational interviewing techniques.
• Coordinate internal and external resources to meet identified needs.
• Interface with Medical Directors and other interdisciplinary team members in the development of care management treatment plans.
• Familiarity with the quality management process and customer-focus care to improve STARS and HEDIS outcomes.
• Continue professional development by attending relevant educational programs at least annually.
• Ability to meet and/or exceed established productivity metrics and standards.
• Conduct comprehensive assessments of health, psychosocial needs, cultural preferences, and support systems.
• Engage the member and/or caregiver to develop an individualized plan of care.
• Arrange resources necessary to meet identified needs.
• Coordinate care delivery and support among member support systems.
• Deliver education on condition management including self-management, glucose monitoring, medication use, nutrition, physical activity, stress reduction, and reducing complications.
• Monitor and evaluate effectiveness of the care management plan.
• Accurately document interactions that support management of the member.
• Adhere to professional standards as outlined by protocols, rules, and guidelines.
• Comply with applicable regulatory and licensing requirements such as NCQA and CMS.
• Monitor, evaluate, and report programs' effectiveness and participate in continuous improvement activities.
• Advocate for members and promote self-advocacy.

Qualifications

• Nursing diploma or associate’s degree in nursing required.
• Bachelor’s degree in nursing or related field preferred.
• Certification in Case Management (CCM) is preferred.
• Certification in Chronic Care Professional (CCP) preferred.
• Certified Diabetes Educator Specialist (CDE) or Certified Diabetes Care and Education Specialist (CDCES) preferred.

Requirements

• Two (2) to four (4) years of related clinical experience required.
• One (1) to three (3) years case management experience required.
• Managed care experience in Medicare case management preferred.
• Experience in med surgical, preventive care, chronic condition education, homecare, critical care, and public health preferred.
• Nursing experience in a clinical, acute/post-acute care, and community setting required.

Benefits

• Pay range: between $63,600 and $106,300.

Company Description

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.