Care Manager I (RN)

Care Manager I (RN)
03 months
Compact License
Remote 100%
Licenses/Certifications:
Current state's RN license.
Remote, compact state needed with NY licensure.
Position Purpose:
Perform care management duties to assess, plan, and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost-effective care
* Develop, assess, and adjust, as necessary, the care plan and promote the desired outcome
* Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long-term goals, treatment and provider options
* Coordinate services between Primary Care Physicians (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
* Develop a plan of care based upon assessment with specific objectives, goals, and interventions designed to meet member's needs
* Provide patient and provider education
* Facilitate member access to community-based services
* Monitor referrals made to community-based organizations, medical care, and other services to support the members' overall care management plan
* Actively participate in integrated team care management rounds
* Identify related risk management quality concerns and report these scenarios to the appropriate resources
* Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Education/Experience:

• Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred.
• 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
• Knowledge of healthcare and managed care preferred. Prior experience working in a remote role is preferred.
• Prior case management experience is preferred. Bilingual in Spanish and English is preferred.

Licenses/Certifications:
Current state's RN license.
Remote, compact state needed with NY licensure. Required Skills/Experience: Preferred Skills/ Experience: 1. Registered Nurse, 5 plus years of clinical RN experience 1. Medicare Case management experience 2. Compact License 2. CCM certification preferred
*Pediatrics - birth to 21
*Work-from-home case management role