[Hiring] RN Care Manager @UHS

Role Description

Under the supervision of the Care Management Clinical Program Manager, the RN Care Manager is responsible for providing care management services for medically and/or socially complex members. The target member population includes individuals with complex medical conditions, social-economic, or mental health needs. The goal of the program is to assist these members in achieving optimal health and/or independence in managing their care.

• Demonstrate and apply knowledge of the philosophy/principles of comprehensive case management.
• Provide patient-centered, culturally sensitive care coordination and management of complex members.
• Adhere to the CMSA Standards of Practice for Case Management.
• Develop comprehensive care plans for member and family self-care competence.
• Conduct motivational assessments and assess for desired level of involvement.
• Coach for adherence to the care plan.
• Assess the member’s needs and create and monitor a specific individualized care plan, including end of life planning.
• Promote knowledge of the Care Management program to Prominence Health Plan contracted physicians and members.
• Develop and sustain partnerships with community resources and support agencies.
• Participate in efforts associated with the successful implementation and operation of the SNP CM program.
• Ensure the model of care (MOC) meets or exceeds regulatory and accreditation requirements for CMS, state Medicaid offices, and NCQA.

Qualifications

• Education: Associate or Bachelor’s Degree in Nursing, required.
• License & Certifications:
  • Active, unrestricted, current, and valid Compact Registered Nurse license in the States of Practice (Nevada, Texas and/or Florida), required, multi-state preferred.
  • Certified Case Manager (CCM), Case Management Nurse – Board Certified (CMGT-BC), Accredited Case Manager – RN (ACM-RN), or Certified Managed Care Nurse (CMCN), preferred.
• Experience:
  • Minimum of three (3) years in clinical nursing practice, required.
  • Minimum of three (3) years of Case Management/Transition of Care experience in a managed care outpatient or community environment, preferred.
  • Recent working knowledge of Special Needs Plan population, preferred.
• Skills:
  • Ability to effectively communicate in English (Nevada, Texas, and Florida markets). Preferred Spanish (Texas and Florida markets), and/or Spanish, French Creole, and/or Tagalog (Florida market), both verbally and in writing depending on the State of RN licensure and employment location.
  • Bilingual; Spanish/English preferred.
  • Experience working with the Medicare and Medicaid population segment, preferred.
  • Knowledge of Medicare/ Medicaid processes and compliance standards, preferred.

Benefits

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!