RN Case Manager

TruHealth; Muncie (IN); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Annual performance wage increases

401k retirement plan with a company"

Medical, dental and vision insurance

$50,000 basic life insurance – paid by

Paid time off

UKG Wallet – access your pay faster!

Holiday pay

Telehealth through 98point6 – free to

Continuing Education opportunities

Job summary

TruHealth is seeking an experienced RN Case Manager to lead care coordination for members enrolled in Medicare Advantage plans. You will visit patients in person or telephonically, consult with physicians to ensure accurate claims, and collaborate with an interdisciplinary team to assess and plan patient care.

The role requires strong communication, organization, and adaptability to changing priorities, with opportunities to contribute to quality improvement and education across care teams.

Qualifications

• RN license in the assigned state is required.
• CCM license preferred.
• 2 years geriatrics experience.
• 2 years managed care experience required.
• 3–5 years case management in a managed care environment preferred.

Responsibilities

• Complete Health Risk Assessments for members.
• Initiate, update and revise care plans as needed.
• Maintain a caseload of patients as assigned.
• Coordinate with interdisciplinary team to assess and plan care.
• Educate members and home/facility staff as needed.
• Coordinate outpatient discharge planning based on patient needs and benefit coverage.
• Participate in audits and prepare reports.

Skills

Communication skills

Team player

Self-starter

Multitasking

Education

RN degree

Bachelor’s degree preferred

Tools

MS Office

Job description

The RN Case Manager is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members who are associated with a Medicare Advantage plan. Visit (in person and/or telephonic) patients to ensure proper nursing care. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.

This position requires an individual who is a self-starter and team player, has the ability to manage multiple priorities, work with minimal supervision on assigned projects and activities, and demonstrates excellent communication and presentation skills. This individual must be able to adapt quickly to change and be able to collaborate with multiple teams

Here are a few of our benefits:

• Annual performance wage increases
• 401k retirement plan with a company match
• Medical, dental and vision insurance
• $50,000 basic life insurance – paid by the company
• Paid time off
• UKG Wallet – access your pay faster!
• Holiday pay
• Telehealth through 98point6 – free to all employees
• Continuing Education opportunities

Qualifications/Requirements:

• Minimum of 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
• 2-years managed care experience required.
• Minimum of 3-5 years’ experience doing case management in a managed care environment preferably with a managed care organization or like facility, Preferred.

Essential Functions:

• Complete Health Risk Assessments for members as assigned.
• Initiate, update and/or revise care plans as needed.
• Maintain a case load of patient as assigned.
• Evaluates, coordinates, and plans patient care in collaboration with an interdisciplinary health team; reassesses and revises plans of care in collaboration with other members of the health care team.
• Provides patient/family education based on identified learning needs utilizing available teaching resources
• Provides education based on identified learning needs utilizing available teaching resources to members of the Home/Facility staff as needed.
• Coordinates outpatient discharge planning based on patient needs, clinical circumstances and benefit coverage.
• Participates in all Managed Care related audits; generates, maintains and tracks periodic and annual reports/documents via MS Office program, e-mails to support Care Coordination program.
• Performs improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports.
• Participates in patient care conferences, committee meetings, staff development and educational programs to increase or maintain professional competency.
• Correctly applies medical management criteria.
• Researches clinical questions from employers, members and payers as required.
• Educate members on health access options.
• Responds, manages, and resolves day-to-day problems presented in care coordination and communicates effectively with the Facility/Home.
• Other duties as assigned.

Education:

• Graduate of an accredited RN program.
• Bachelor’s Degree preferred.

Licensure/Certifications:

• Current license to practice as a register nurse in assigned state.
• Current CCM license, Preferred
• CPR for Healthcare Professionals certification.
• Current motor vehicle insurance.

Qualifications

Experience

Required

2 years: Geriatric Care

Preferred

2 years: Skilled Nursing

Licenses & Certifications

Required

Registered Nurse

Equal Opportunity Employer
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