Clinical - Care Manager (RN)

Axelon Services Corporation; Columbia (SC); Remote; USD 60,000 - 85,000; Full time

Job summary

A leading healthcare services company is seeking a Registered Nurse to provide high-quality care management for members with complex needs. This remote position entails developing personalized care plans, collaborating with healthcare providers, and ensuring members receive optimal services. The ideal candidate will hold a nursing degree and possess strong case management skills, particularly in obstetrical care. This opportunity focuses on enhancing healthcare outcomes through effective communication and resource coordination.

Qualifications

• Requires a Degree from an Accredited School of Nursing.
• Experience in obstetrical nursing in a clinical setting.
• RN license required.
• Performance in case management.

Responsibilities

• Evaluates needs and develops care plans for members.
• Collaborates with providers and stakeholders for care.
• Provides education and ongoing support to members.

Skills

Obstetrical nursing

Case management

Knowledge of Managed Care

Communication

Education

RN - Registered Nurse - State Licensure

BSN preferred

Tools

MS Office

Job description

Location : Remote work from home – must live in SC

Shift : M-F -, No OT

Job Description : Position Purpose :

Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

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 provides appropriate care management interventions.
• Coordinates between the member, family / caregivers, and care provider team to ensure members receive adequate, 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; collaborates with members, caregivers, and providers to revise or update plans as needed.
• Provides resource support to members and care managers for local services (employment, housing, participant direction, independent living, justice, foster care) based on assessments.
• Facilitates care management and collaborates with providers or specialists for timely access to needed care or services.
• Performs outreach via phone, digital means, home visits, or other sites to assess needs and coordinate resources.
• Maintains all member information and care management activities in compliance with regulations.
• Provides education to members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and benefits.
• Offers feedback to leadership for improving care quality and delivery cost-effectively.
• Performs other duties as assigned by leadership to meet business needs.

Additional notes :

• Describe the day-to-day responsibilities and project details related to case management of high-risk OB members via telephonic outreach.
• Performance metrics include managing a caseload, conducting chart audits, and outreach to a minimum number of members daily.

Required Skills / Experience : + years obstetrical nursing in a clinical setting (not pediatric), case management, knowledge of Managed Care.

Education Requirement : RN license

Preferred : BSN (not required)

Software Skills Required : MS Office (Outlook, Word, Excel, Teams)