Location : Remote, MI Market
Shift : am to : PM EST
am to : PM EST
Walk me through the day-to-day responsibilities of this the role and a description of the project :
- Remote telephonic case management, Care manager (CM) follows model of care to assist member in managing health care needs.
- Conducts initial assessments, medication review, develops care plan with member, identifies member needs and connects member with appropriate resources to meet health care needs.
- Interacts with members care team, community services, vendors.
- Follows up with member every days at minimum to review conditions, progress toward goals, and ensure member is receiving requested information and / or services.
- Provides education on member health plan and coverage and management of identified health conditions.
Describe the performance expectations / metrics for this individual and their team :
CM caseload expectation is actively managed members, Audit score of %or greater, Case duration days.
Education / Experience :
Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and years of related experience.
License / Certification :
RN - Registered Nurse - State Licensure and / or Compact State Licensure required.
Job Duties :
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
Provides resource support to members and care managers for local resources for various services (, employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
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
Provides and / or facilitates education to members and their families / caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Required Skills / Experience : Preferred Skills / Experience : .
Registered Nurse, plus years clinical RN experience . Medicare Case management experience . Compact License . CCM certification .
- Education Requirement : Graduate of accredited RN program Education Preferred : RN, BSN Software Skills Required : Microsoft office products Required Certifications : Compact Preferred, CCM preferred Required Testing :
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