Case Manager

Valid8 Financial, Inc.; Austin (TX); Remote; USD 50,000 - 90,000; Full time

Job summary

An innovative health plan provider is seeking a dedicated Case Manager to join their Population Health Team. This role focuses on coordinating care for members with complex health needs, ensuring they receive the right resources and support. As a Case Manager, you will advocate for clients, develop tailored care plans, and work closely with a team to enhance health outcomes. This is a full-time remote position, allowing you to make a significant impact in a flexible work environment. If you're passionate about improving healthcare delivery and enjoy working in a dynamic setting, this opportunity is for you.

Benefits

Flexible work hours

Office equipment provided

Work from home stipend

No travel required

Qualifications

• Must be a licensed RN with experience in case management.
• Preferred certifications include CCM and CMCN.

Responsibilities

• Coordinate patient care plans with caregivers and providers.
• Develop individualized care management plans for members.

Skills

Verbal and written communication skills

Knowledge of discharge planning

Ability to work in a fast-paced environment

Familiarity with community agencies

Bilingual - Fluent in Spanish and English

Education

Graduate of an accredited nursing program

Certified Case Manager (CCM)

Bachelor of Science in Nursing degree (BSN)

Tools

PC

Monitor

Headset

Job description

Summary/Objective:
Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health plan reinvented for a post-pandemic world that is built around whole-person affordable preventive care featuring more benefits. $0 copays and $0 deductibles when members complete the Baseline Visit within 120 days of enrollment into the Plan. The Population Health Team is responsible for driving improved health outcomes, leveraging a data-first mindset to help our members achieve their optimal health well-being. Within the Population Health team, Case Managers work very closely with the Care Navigation team and are at the core of the Curative member-oriented health plan. Our Case Managers serve as a central point of contact to handle our most clinically complex members and members that want assistance in achieving their health goals.

Essential Functions:

• Serve as a Clinical Care Navigator, working to coordinate the patient’s plan of care with caregivers and providers.
• Facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.
• Collect and assess member information pertinent to a member’s history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services.
• Based on the needs and values of the member, and in collaboration with all service providers, the Case Manager links members with appropriate providers and resources throughout the continuum of health and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable.
• Case Managers have direct communication with the member, care providers, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.
• Coordinates with Care Navigators (non-licensed staff) on an ongoing basis to maximize the educational outreach to members through established workflows and processes.
• Participates in supporting new Curative programs and their implementation.
• Participation with clinical team meetings and/or conferences as appropriate and assigned.
• Consistently meets established performance metrics and contractual obligations.
• Consistently review and abide by Curative policies and procedures.
• Other duties as assigned to support team.

Education:

• Graduate of an accredited nursing program with current RN licensure in good standing.
• Preferred: Certified Case Manager (CCM), Certified Managed Care Nurse (CMCN) or other relevant certifications.
• Preferred: Bachelor of Science in Nursing degree (BSN).

Experience:

• At least 2 years minimum experience working as a Case Manager in a health plan setting.
• Background in managed care - experience working with vulnerable populations who have acute, chronic, or complex psychosocial needs.
• Preferred: experience working in a start-up environment.

Skills:

• Ability to be nimble and work in a fast paced and changing environment.
• Current knowledge of services provided across the continuum of care that involve multiple systems addressing the ongoing needs of members.
• Knowledge of discharge planning and transitions of care is essential.
• Familiarity with community agencies and with how to make appropriate referrals to them.
• Excellent verbal and written communication skills.
• Ability to engage patient/family in discussion of health care goals and decisions with attention to cultural and health literacy implications.
• Preferred: Bilingual - Fluent in Spanish and English (verbal and written communication).
• This job operates in a remote environment with the need to have a reliable internet and phone connection.
• Must have a quiet place, secure, with no distractions to perform duties for work from home.
• Must have password protected, stable internet access - stipend will be provided.
• Work location MUST be secure and private to maintain HIPAA compliance for work from home.
• Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset.
• While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
• The employee is frequently required to reach with hands and arms.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
• We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid.

Position Type/Expected Hours of Work:
This is a full-time salaried remote position. Typical work hours are Monday through Friday, 8:00 AM to 5:00 PM local time with flexibility as needed to support different time zones. Our headquarters are in Austin, TX so we often operate on Central Time.

Travel:
No travel is expected with this role, but may be optional for department offsites.

Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.