Case Manager
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Job Description
Remote Case Manager coordinating medical, psychosocial, and alternative care plans. Supporting patients, providers, payors, and interdisciplinary teams for Nova Healthcare Administrators.
Responsibilities:
- Apply the six essential case management activities: assessment, planning, implementation, coordination, monitoring, and evaluation
- Assess patients’ immediate and long-term medical and social needs
- Develop and continuously evaluate individualized plans of care
- Monitor quality and effectiveness of care
- Ensure regulatory, privacy, payment, reimbursement, and appeal-process compliance
- Coordinate decisions and documentation and maintain an accurate database
- Build relationships with interdisciplinary teams and communicate case objectives
- Advocate for patients and identify potential complications
- Apply the Americans with Disabilities Act and relevant federal legislation
- Research community resources and establish support systems
- Communicate available services and help patients obtain them
- Identify and implement alternative care levels and resources
- Evaluate quality and cost effectiveness with payors and providers; negotiate discounts when appropriate
- Document plans of care timely
- Participate in training and education committees
- Support, guide, and train support staff
- Perform assignments professionally
Requirements:
- Registered Nurse (RN) with active, current, unrestricted license in a Nurse Licensure Compact (NLC) state required
- Case Management Certification (CCM) required; candidates without CCM must obtain it within three years of commencing employment
- Three years of clinical RN experience in a med/surg or ambulatory care setting required
- Clinical experience in Behavior Health, Transplant, Neo-Natal, or Oncology preferred
- Previous experience in managed care a plus
- Clinical knowledge of health or social work needs for the population served
- Ability to identify barriers to successful care management
- Ability to interact effectively with physicians and healthcare team members
- Excellent problem-solving and time management skills
- Excellent written, verbal, and interpersonal communication skills
- Ability to complete job duties independently and proficiently
- Flexibility in work schedules and assignments
- Proven examples of Nova’s Core 4
- Knowledge of multi-state licensure scope of practice
- Immigration or work visa sponsorship will not be provided
Benefits:
- First-class perks and benefits
- Scorecard incentive eligibility
- Full range of benefits
- Generous paid time off
- Continuing education opportunities
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