RN Care Manager

Network Health Administrative Services, LLC; Menasha (WI); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization seeks a Registered Nurse Care Manager to provide member-centric case management services. This role emphasizes advocacy and coordination of care across the healthcare continuum, requiring strong communication skills and a deep understanding of health needs. Ideal candidates will have experience in nursing and case management.

Qualifications

• RN licensure in the State of Wisconsin is required.
• Preferred experience in case management and utilization management.
• Four years of clinical healthcare experience as an RN.

Responsibilities

• Provide case management services including assessment and care coordination.
• Educate individuals and families about health conditions and resources.
• Coordinate care among providers for quality, cost-effective outcomes.

Skills

Patient Advocacy

Care Coordination

Motivational Interviewing

Education

Bachelor's degree in Nursing

Graduation from accredited school of nursing

Job description

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes.

Check out our2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies
• Screens candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluates and determines member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies
• Reviews results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; closes cases when expected goals/outcomes are achieved
• Provides information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff
• Evaluates and processes member referrals from physicians to other specialty providers
• Assess, plans, facilitates and advocates for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met
• Works with members and families on self-management approaches using coaching techniques such as motivational interviewing
• Educates the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes
• Facilitates the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality
• Schedules visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning
• Stays abreast of current best practices and new developments
• Other duties as assigned

Job Requirements:

• Graduation from accredited school of nursing
• Bachelor’s degree in Nursing preferred
• Four years of clinical health care experience as a RN
• Previous experience in case management, utilization management, insurance, or managed care preferred
• Experience with Medicare, Medicaid preferred
• May require four (4) years of behavioral health experience.
• RN licensure in the State of Wisconsin
• Case Management certification preferred.

** This position is eligible to work out of your home office in the state of Wisconsin. Travel to the corporate office will be required occasionally for the position.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.

Qualifications

Licenses & Certifications

Required

Registered Nurse

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.