Complex Case Manager RN - (Remote)

Santa Barbara Cottage Hospital; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

Eine etablierte Einrichtung im Gesundheitswesen sucht einen engagierten Fallmanager, der die Verantwortung für eine Gruppe von Mitgliedern mit unterschiedlichen Gesundheitsbedürfnissen übernimmt. In dieser Rolle werden Sie Pflegepläne entwickeln, Barrieren überwinden und Ressourcen nutzen, um die Gesundheitsziele der Mitglieder zu erreichen. Sie werden auch die Qualität der Ergebnisse überwachen und sicherstellen, dass alle Aktivitäten den relevanten Standards entsprechen. Diese Position bietet die Möglichkeit, einen bedeutenden Einfluss auf das Leben der Patienten zu haben und Teil eines dynamischen Teams zu sein, das sich für die Verbesserung der Gesundheitsversorgung einsetzt.

Qualifications

• 7 Jahre Erfahrung in klinischer Fallverwaltung oder Gesundheitsmanagement.
• Zertifizierung in Fallmanagement ist bevorzugt.

Responsibilities

• Entwicklung und Umsetzung von Pflegeplänen für Mitglieder.
• Überwachung der Qualitätsergebnisse und Einhaltung von Standards.

Skills

Kommunikationsfähigkeiten

Verhandlungsgeschick

Interpersonelle Fähigkeiten

MS Excel Kenntnisse

Datenanalyse

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This role involves ownership and oversight of a specific panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, utilizes data and analytics alongside clinical judgment to determine appropriate interventions, and manages a caseload of members enrolled in case management. Responsibilities include developing care plans, encouraging behavioral change, addressing barriers, coordinating care, and leveraging resources to meet health goals. The role also entails monitoring and improving quality outcomes across clinical, financial, and functional metrics.

ESSENTIAL RESPONSIBILITIES

1. Maintain oversight of the member panel by assessing health needs and referring to appropriate resources.
2. Create and implement care plans with goals and scheduled re-assessments.
3. Achieve targeted patient outcomes, including care plan realization.
4. Document all activities in compliance with standards and regulations.
5. Stay informed of and adhere to relevant regulatory and practice standards.
6. Perform other duties as assigned.

EDUCATION

• Required: High School Diploma/GED
• Preferred: Bachelor's Degree in Nursing

EXPERIENCE

• Required: 7 years of clinical, case management, disease management, provider operations, or health insurance experience
• Preferred: Training in CBT, motivational interviewing, DBT, experience with diverse populations, and cultural competency understanding

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY; others must be obtained within 6 months
• Preferred: Certification in Case Management

SKILLS

• Strong communication, negotiation, and interpersonal skills
• Knowledge of disease processes and healthcare costs
• Proficiency in MS Excel and data analysis
• Ability to work in a team and manage multiple priorities
• Self-directed with moderate autonomy

OTHER REQUIREMENTS

• Travel: 0-25%
• Physical demands include lifting up to 25 pounds rarely; office-based with occasional site travel

Note: The description is designed to outline essential duties and may not include all responsibilities.