Integrated Care Manager (RN)

Overview

Conducts health risk assessments, coordinates care, and manages cases for Medicare members.

Key Responsibilities

• case management
• risk assessment
• care coordination
• clinical documentation
• member education
• referral management

Tasks

-Assists the Health Services Team in implementing best practices for chronic care and disease management. -Follows the patient through various transitions of care to ensure that any gaps in treatment plans are identified and remedied, and promote efficient health care delivery. -Documents and tracks clinical reviews, member care plans, referrals, and findings. -Participates in assessment activities to develop individualized care plans in coordination with the patient, family, and providers. -Performs assessments of members, including Health Risk assessments per CMS regulation -Works collaboratively with the member (and caregivers), primary care physicians, specialists, and other care providers to ensure member compliance and adherence to the medical plan of care. -Interacts with Medical Directors, Pharmacists, Social Workers, Behavioral Health Clinicians, and Other Impact Team Members on cases -Serves as a member advocate and resource, and provides critical information and recommendations to the rest of the care team. -Applies case management standards of practice to focus on effective care of high-need members. -Provides member education to assist with self-management and encourages members to make healthy lifestyle changes. -Follows standard protocols, processes, and policies. -Makes referrals to outside sources.

Requirements

• rn
• license
• case management
• bilingual
• managed care
• pc proficiency

What You Bring

-Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization. -Current, valid, unrestricted license -3 years of managed care experience or other commensurate experience -Registered Nurse (RN) with 3 years of direct clinical care to the consumer in a clinical setting. -Knowledge of plan benefit designs. -Personal management skills — Plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments. Teamwork — ability to work well with one or more groups. -Certification in Case Management or a nationally recognized health care certification. -Patient education experience. -CM or DM experience with a Managed Care Organization (MCO) -Ability to demonstrate knowledge of and apply those to the job function and responsibilities. -PC proficiency to include Outlook, Word, Excel, database experience, and web-based applications. -Bilingual – English and Spanish -Problem-solving skills: the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action. -Verbal and written communication skills, including listening, discussing, and documenting medical needs with members, providers, internal staff/management, external vendors, and community resources. -Demonstrated ability to perform case management & disease management activities. -Maintains strong knowledge of Case management, community resources, and plan benefits to promote improved member experience and health outcomes. -Demonstrates strong clinical knowledge, ability to perform clinical assessments, ability to use critical thinking skills and has the capacity for continued learning.

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Benefits

-A competitive salary based on the market -Employer-Paid Life Insurance -401(K) match up to 4% -Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc. -Medical, Dental, and Vision

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