RN Case Manager – Transition of Care (Outpatient) – Remote

Alignment Health; United States; Remote; USD 80,000 - 120,000; Full time

Job summary

Alignment Health seeks an experienced Registered Nurse (RN) for complex and chronic care case management—primarily telephonically. You will assess, develop, coordinate, and monitor care plans to optimize member health in alignment with policy and regulations.

The role requires a current RN license, 5+ years of clinical case management, and an ability to lead, teach, and collaborate with diverse teams. Strong communication and problem-solving skills are essential in a fast-paced environment.

Qualifications

• Experience: Minimum 5 years of clinical case management experience or equivalent education/experience.
• Education: Associates or Bachelor's degree in Nursing.
• Licensure: Current, unrestricted RN license in the state of application.
• Specialized Skills: Ability to communicate positively, professionally and effectively; provide leadership, teach and collaborate with others.
• Excellent written and oral communication; ability to establish relationships with diverse members, management, employees and vendors.
• Problem-solving, organizational and time management skills for a fast-paced environment.

Responsibilities

• Ensure access to services appropriate to health needs.
• Identify, assess and manage members per established criteria.
• Implement care plans by facilitating authorizations/referrals within benefits or through extra-contractual arrangements.
• Monitor and evaluate care plans and modify as needed.
• Interface with Primary Care Physicians, Hospitalists, NPs, and specialists on care plans.

Skills

Communication

Leadership

Problem-solving

Time management

Collaboration

Education

Associates or Bachelor's degree in Nursing

Job description

the company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the the company community. Working at the company provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Responsible for health care management and coordination within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Coordinates and monitors Alignment Healthcare member’s progress and services to ensure consistent cost-effective care that complies with Alignment policy and all state and federal regulations and guidelines. Performs duties mostly telephonically.General Duties/Responsibilities1. Ensures member access to services appropriate to their health needs.2. Identifies, assesses, and manages members per established criteria.3. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Uses independent judgment to determine appropriateness of such authorizations. Deploys internal and external resources to meet identified needs.4. Monitors and evaluates effectiveness of the care management plan and modifies, as necessary.5. Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans.6. Negotiates rates of reimbursement, as applicable.7. Assists in problem solving with providers, claims or service issues.8. Measures the effectiveness of interventions to determine case management outcomes.9. Participates and provides feedback in the development of utilization/care management policies and procedures.10. Counsels and engages in personal discussions with patients and their families on available care options. Helps them to determine their appropriate and preferred course of action.

Job Requirements:Experience: Required: Minimum 5 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background.

Education: Required: Associates or Bachelor's degree in Nursing.

• Preferred: BSNSpecialized Skills: Required:
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Licensure: Required: Current, unrestricted RN license in the state for which you are applying

• Preferred:Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $79,697.00 - $119,545.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

the company is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.