Clinical - Care Manager I (RN)

Location: *Work-from-home case management role
REMOTE- CST, but MUST have compact licensure minimum. Prefer to also have MI, CA, OR licenses in addition to compact.

SHIFT: Mon - Fri 8am - 5 PM CST, No OT

Job Description: Description - External
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 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 Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
• Develop 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
Qualifications - External

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. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.

Licenses/Certifications: Current state’s RN license.

Walk me through the day to day responsibilities of this the role and a description of the project:

• Outreaching member to enroll them in CM program
• Building care plans, medication review, assessments care plans

Describe the performance expectations/metrics for this individual and their team:

• 20 calls/day

Tell me about what their first day looks like:

• System-specific training

What previous job titles or background work will in this role?

• Case Management that has remote experience
• Home Health Care/Hospice, but not their only experience.

Required Skills/Experience:				Preferred Skills/ Experience:
1.	Time Management (work fast-paced environment)			1.	Technical skills
2.	Works independently			2.
3.	Work remotely in telephonic CM			3.
Education Requirement:		RN		Education Preferred:
Software Skills Required:		Microsoft Office Suites
Required Certifications:				Required Testing: