CCM Case Management RN

Oscar-Health-; Atlanta (GA); Remote; USD 45,000 - 58,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

11 paid holidays

Paid sick time

Parental leave

401(k) plan

Life and disability insurance

Wellness time

Job summary

Oscar Health is hiring a CCM Case Management RN for a telephonic role that educates members, coordinates care across settings, and supports transitions with a focus on improving health outcomes.

The position reports to the Manager, Clinical Programs. Work location is remote, open to candidates in AZ, FL, GA, and TX; optional travel for meetings and events may be required.

Qualifications

• Active, unrestricted RN license in your state of hire.
• CCM certification and BSN.
• Working knowledge of Milliman Care Guidelines.
• Bilingual in Spanish or Creole.
• Previous remote-work experience preferred.

Responsibilities

• Coordinate care across ER, inpatient, post-acute, outpatient, and home care while maintaining confidentiality and professionalism.
• Reach out to members facing health challenges to guide them through the healthcare system.
• Complete biopsychosocial assessments to identify member needs.
• Develop outcome-based plans with target dates.
• Assist with safe discharge planning and advocate for appropriate care.

Skills

RN Licensure

CCM Certification

Milliman Care Guidelines

Bilingual (Spanish or Creole)

Education

BSN

Job description

Hi, we're Oscar. We're hiring a CCM Case Management RN to join our team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

Telephonic case management role in which you will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with the Clinical Concierge Specialist and other Oscar teams to ensure exceptional care for our members.

You will report into the Manager, Clinical Programs.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia and Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Internal applicants living outside of the listed location(s) will be considered for this role provided they meet all job requirements and internal transfer eligibility criteria.

Pay Transparency: The base pay for this role is: $32.60 - $42.79 per hour. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Assist in the coordination of care across a variety of settings (ER, inpatient, post acute, outpatient, home care) while maintaining strict confidentiality and the highest level of professionalism.
• Actively reach out to members undergoing difficult health challenges and help guide them through the healthcare system to improve their overall experience.
• Complete a comprehensive biopsychosocial needs assessment to help identify member needs.
• Develop an outcome-based plan of care, based on the member’s input and assessed clinical and social needs with anticipated targeted dates for accomplishment.
• Proactively reach out to hospital case managers to assist with safe discharge planning to appropriate level of care or home.
• Seek guidance from medical directors to advocate for members to get the appropriate care they need. Act as a member advocate and assist with problem solving, as well as addressing any barriers to care or compliance with the care plan.
• Educate other teams on the CCM program and collaborate to identify high risk members who would be appropriate.
• Work with non-clinical teammates in assisting members to navigate the healthcare system, including coaching non-clinicians on how they can add value to all member interactions.
• Communicate with members via phone, secure messaging, and in person to provide education on health conditions, new medications, and procedures.
• Participate in surveys, studies, and special projects as assigned.

Requirements:

• 2+ years of clinical experience.
• Active, unrestricted Nursing license (RN) in your state of hire and ability to obtain additional licensure as needed.
• Working knowledge of Milliman Care Guidelines
• CCM certificationBSN
• Previous work from home and proven comfort with accessing systems remotely
• Bilingual in Spanish or Creole

This is an authentic Oscar Health job opportunity.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Oscar Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.