[Hiring] Clinical Care Manager (RN) @Mindlance

Role Description

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.

Responsibilities

• Evaluates the needs of the member, barriers to accessing appropriate care, and social determinants of health needs.
• Develops ongoing care plans/service plans and collaborates with providers to identify resources to address member's unmet needs.
• Identifies problems/barriers to care and provides appropriate care management interventions.
• Coordinates between the member and/or family/caregivers and the care provider team to ensure adequate person-centered care.
• Provides ongoing follow-up and monitoring of member status and progress towards care plan goals.
• Provides resource support to members and care managers for local resources based on service assessment and plans.
• Facilitates care management and collaborates with providers to ensure timely access to needed care or services.
• May perform telephonic, digital, home, and/or other site outreach to assess member needs.
• Collects, documents, and maintains all member information and care management activities for compliance.
• Provides education to members and their families/caregivers on disease processes and healthcare benefits.
• Provides feedback to leadership on opportunities to improve care and quality delivery.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing.
• 2 – 4 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• For YouthCare Illinois plan: Bachelor’s Degree and IL RN licensure required. Must reside in IL.
• For Sunshine Health (FL): Minimum of two years of pediatric experience required.

Requirements

• Experience in supporting OB/NICU preferred.
• Managed care experience is a plus but not a must.
• Must have a professional and quiet work atmosphere.
• Frequent job hopping may disqualify candidates.

Benefits

• Opportunity to support high-risk pregnant members.
• Fast-paced environment with a caseload of approximately 80-90 members.
• Audit expectation of 95% for documentation compliance.