Case Manager RN (46114)

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

Job summary

A leading health care provider is seeking a Case Manager RN to improve member wellness through coordinated care. This role involves telephonic case management, patient advocacy, and collaboration with health care teams. The ideal candidate will have a strong nursing background and excellent communication skills, working in a remote environment while adhering to confidentiality and security policies.

Qualifications

• Previous 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 and caregivers on conditions and self-management techniques.

Skills

Communication

Organization

Attention to Detail

Education

Active Registered Nurse license in the state of Oklahoma

Active multi-state RN license

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

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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 RESPONSIBILITIES:

• 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 department's 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.
• Coordinates services for members, including community resources and collaboration with other members of the care team.
• Educates members and their caregivers on conditions and self-management techniques.
• Initiates and participates in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT.
• Completes 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. 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 safeguards to protect records from unauthorized access, disclosure, or damage, and will adhere to all privacy and security policies.

Travel:

N/A

Supervisory Responsibility:

N/A

Other Duties:

This job description is not comprehensive; duties may change at any time with or without notice.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care