Case Manager, RN
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Job Description
Case Manager RN coordinating telephonic care for GlobalHealth, a Medicare Advantage HMO insurer. Advocating for high-risk members through assessments, care planning, provider coordination, and transitions of care.
Responsibilities:
- Conduct telephonic case management for complex, high-risk members, including needs identification and assessment, care planning and coordination, and outcome monitoring
- Coordinate with providers to support holistic, healthy, beneficial outcomes
- Maintain awareness of patient needs and condition changes through interdepartmental communication, network communication, and member outreach
- Provide patient advocacy, support, quality-care assessment, and crisis intervention
- Coordinate member services, including community resources, with other care-team members
- Educate members and caregivers about conditions and self-management techniques
- Initiate and participate in SNP MOC elements, including HRA completion, ICP creation, and ICT initiation
- Complete transition-of-care activities, including post-discharge assessment, medication reconciliation/review, and ensuring follow-up-care access
Requirements:
- High School or Equivalent education level
- Active Registered Nurse license in the state of Oklahoma required
- Active multi-state RN license preferred
- Previous experience in managed care/utilization management preferred
- Knowledge of current nursing processes, techniques, and established standards
- Knowledge of disease management, medications, and community resources
- Strong attention to detail and organizational, multitasking, and time-management skills
- Ability to communicate clearly and effectively orally and in writing
- Knowledge of Microsoft Word, Excel, and PowerPoint
- Ability to work independently or as a team member
- Reliable and secured internet connection
- Ability to maintain confidentiality of business information and Protected Health Information in accordance with HIPAA and company policy
- Ability to follow company privacy and security policies
Benefits:
- Remote work environment
- No travel required
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