[Hiring] Nurse Case Manager II @Iconma Portal

Role Description

Our client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Remote/IL location.

• The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).
• The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap-around services to promote effective utilization of available resources and optimal, cost-effective outcomes.
• Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member’s overall health through integration.
• Conducts comprehensive assessments of member’s needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and addresses complex health and social indicators which impact care planning and resolution of member issues.
• Completes assessments that take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member’s restrictions and limitations.
• Analyzes utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow-up to members to help ensure they are receiving the appropriate treatment and services.
• Applies and/or interprets applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and member’s needs to ensure appropriate administration of benefits.
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
• Consults with manager, medical directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives using a holistic approach.
• Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes.
• Works collaboratively with the members’ interdisciplinary care team.
• Identifies and escalates quality of care issues through established channels.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
• Utilizes care management processes in compliance with regulatory and company policies and procedures.
• Facilitates clinical hand-offs during transitions of care.

Qualifications

• Minimum Associates or diploma nursing degree required
• 3-5 years clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• BSN preferred
• Case management in an integrated model preferred
• Managed care experience preferred
• Discharge planning experience preferred
• Experience providing care to the Medicaid population preferred
• Spanish Speaking Preferred
• RN with current unrestricted IL state licensure required

Benefits

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities