Part-Time Telephonic Case Manager RN | Impactful Care

Santa Barbara Cottage Hospital; United States; Remote; USD 51,577,000 - 54,443,000; Part time

Benefits offered by this job

Part-time schedule

Learning & development

Mentorship

Competitive pay

Tech equipment

Job summary

Personify Health is seeking a Part-time Case Manager RN to perform telephonic case management for health plan participants. You will assess needs, review claims data, and develop collaborative treatment plans with patients and care teams to optimize outcomes and control costs.

The role requires California RN licensure, 5+ years of medical/surgical acute care with case management exposure, and the ability to coordinate care across providers and families.

Qualifications

• Graduation from an accredited Registered Nursing (RN) program.
• Current California RN license; a multi-state license will also be required.
• Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management.
• Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management.

Responsibilities

• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
• Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
• Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
• Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
• Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
• Evaluate and make referrals for wellness programs.
• Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low-risk cases ensuring confidentiality according to Company policy and HIPAA
• Perform Utilization Review for assigned members.
• Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues

Skills

Claims data

Discharge planning

Independent worker

Community resources

MS Office

Interpersonal skills

Negotiation

Time management

Organized

Education

RN program completion

California RN license

Multistate license

Tools

Microsoft Office Suite

Job description

Personify Health is seeking a Part-time Case Manager RN to perform telephonic case management for health plan participants. You will assess needs, review claims data, and develop collaborative treatment plans with patients and care teams to optimize outcomes and control costs.

The role requires California RN licensure, 5+ years of medical/surgical acute care with case management exposure, and the ability to coordinate care across providers and families.