Clinical - Care Manager (RN)

Location: 100% Remote work from home-Must live in SC

SHIFT: Mon - Fri 8am - 5PM ( *There will be no overtime granted for these positions)

Job Description:

• Transition of Care Case Management for Medicaid members, telephonic outreaches to facilities and members. Assist facility staff with discharge planning efforts for members.

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

• Outreaches to members after discharge from hospitalizations within 10 business days of discharge.

Position Purpose: Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome. Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs. Identifies problems/barriers to care and provide appropriate care management interventions. Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services. Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs. Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services. May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources. Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:					Preferred Skills/ Experience:
2+years of nursing experience			1.	Case Management
Case management experienced preferred, not required.			2.
Great computer skills and knowledge of navigating the systems			3.
Committment
Education Requirement:	RN license (SC)				Education Preferred:	BSN preferred but not required
Software Skills Required:	MS office – Outlook, Word, Excel, Teams