RN Care Manager
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Job Description
Remote RN Care Manager coordinating medical, behavioral, and psychosocial care for Capital Blue Cross members. Managing complex caseloads, referrals, care plans, resources, and health outcomes.
Responsibilities:
- Coordinate services for members who meet established criteria
- Educate members and promote self-management, quality care, and cost-effective outcomes
- Assess member needs and review service and resource options
- Develop and implement individualized plans of care
- Coordinate resources and monitor member progress
- Evaluate member status and discharge members when criteria are met
- Document the individualized member care management process and outcomes
- Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs
- Provide counseling and referrals to community, local, and state programs
- Collaborate with caregivers, providers, community agencies, behavioral health teams, and other resources
- Manage and oversee a caseload of moderate- to high-risk members with complex needs
- Serve as a liaison among participants, families, physicians, and treatment-team members
- Analyze and evaluate referrals for potential program enrollment
- Conduct assessments to determine acuity, functional status, psychosocial status, and barriers
- Obtain required consent forms
- Apply discharge criteria and discharge members from care management programs
- Identify and report quality-of-care issues
- Maintain member confidentiality
- Attend company and departmental meetings and training sessions
Requirements:
- Registered Nurse with active licensure in home state
- Additional state licensure as needed/required to meet customer needs
- Certified Case Management certification within 2 years of employment
- At least three (3) years’ recent/related experience
- Knowledge of NCQA standards for Population Health Management
- Knowledge of DMAA standards for disease management
- Knowledge of CMSA Standards of Practice for Case Management
- Knowledge of Act 68, CMS, and ERISA
- Knowledge of evidence-based guidelines for chronic conditions/care management
- Knowledge of clinical and managed care principles and operations
- Knowledge of current and emerging medical treatment modalities and best practice guidelines
- Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques
- Proficiency in Microsoft Office Products
- Strong clinical process, critical thinking, and problem-solving skills
- Ability to work autonomously and as part of an interdisciplinary team
- Compact RN license preferred
- Care management, home health, medical/surgical behavioral health, and/or critical care experience preferred
- Health plan experience preferred
- Experience in health coaching and motivational interviewing techniques preferred
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Retirement Plan
- Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Flexible work environment
- Training and continuing education
- Community volunteering opportunities
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