RN Case Manager

Shedule : Mon-Fri 8am to 5 pm Description This position is working remotely and will require home visits and possible visits to Nursing Facility. Local travel : 50-75% Territory includes Dallas, Ellis, Navarro, Kaufman, Rockwall, Hunt, Collin and / or Tarrant coun Case load : 60-95 please add to resume : RN with current unrestricted state licensure, and location please ensure that the candidate is comfortable driving, this role requires travel up to an hou - Nurse Case Manager is responsible for telephonically and / or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. - Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. - Services strategies policies and programs are comprised of network management and clinical coverage policies. - Coordinates and implements assigned care plan activities and monitors care plan progress - Conducts multidisciplinary review in order to achieve optimal outcomes - Identifies and escalates quality of care issues through established channels - Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and / or healthcare needs - Utilizes influencing / motivational interviewing skills to ensure maximum member engagement and promote lifestyle / behavior changes to achieve optimum level of health - Provides coaching, information and support to empower the member to make ongoing independent medical and / or healthy lifestyle choices - Helps member actively and knowledgeably participate with their provider in healthcare decision-making - Monitoring, Evaluation and Documentation of Care : Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Enable Skills-Based Hiring No Qualification Duties This position is work from home and will require home visits and possible visits to Nursing Facility. Local travel : 50-75% Territory includes Dallas, Ellis, Navarro, Kaufman, Rockwall, Hunt, Collin and / or Tarrant county - Nurse Case Manager is responsible for telephonically and / or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. - Services strategies policies and programs are comprised of network management and clinical coverage policies. - Coordinates and implements assigned care plan activities and monitors care plan progress Conducts multidisciplinary review in order to achieve optimal outcomes - Identifies and escalates quality of care issues through established channels - Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and / or healthcare needs Utilizes influencing / motivational interviewing skills to ensure maximum member engagement and promote lifestyle / behavior changes to achieve optimum level of health - Provides coaching, information and support to empower the member to make ongoing independent medical and / or healthy lifestyle choices - Helps member actively and knowledgeably participate with their provider in healthcare decision-making - Monitoring, Evaluation and Documentation of Care : Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Experience License Registered Nurse 3 years clinical practice experience 1 year Case Management experience Position Summary : The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and / or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license Education : RN with current unrestricted state licensure. Employment Type : Full Time Salary : $38 - $39 Hourly Bonus / Commission : No