Case Manager RN (46114)

GlobalHealth, Inc.; Oklahoma City (OK); Remote; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare company is seeking a Case Manager to improve member wellness through effective care management. This remote position involves telephonic case management, coordination with providers, and patient advocacy. Ideal candidates will have an active RN license and experience in managed care. Strong communication and organizational skills are essential to succeed in this role.

Qualifications

• Active RN license in Oklahoma required.
• Experience in managed care/utilization management preferred.

Responsibilities

• Conducts telephonic case management for complex, high-risk members.
• Coordinates with providers to ensure beneficial outcomes.
• Educates members on conditions and self-management techniques.

Skills

Attention to Detail

Organization

Time Management

Communication

Education

Active Registered Nurse license

Multi-state RN license

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Description

POSITION SUMMARY:

This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures.
• Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes.
• Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges.
• Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention.
• Coordination of services for members, including community resources and collaboration with other members of the care team.
• Educate members and their caregivers on conditions and self-management techniques.
• Initiate and participate in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT.
• Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.
  
  

Qualifications

EDUCATION AND EXPERIENCE:

• Active Registered Nurse license in the state of Oklahoma required
• Active multi-state RN license is preferred
• Previous experience in managed care/utilization management preferred
  
  

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources.
• Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals.
• Must be able to communicate, both orally and in writing, clearly and effectively
• Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
• Proven ability to work independently or as a member of a team.
  
  

WORK ENVIRONMENT:

Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

TRAVEL:

N/A

SUPERVISORY RESPONSIBILITY:

N/A

OTHER DUTIES:

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.