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Nurse Case Manager II

Iconma Portal
5 days ago
Remote
Worldwide
$16 - $44.14 USD hourly
General
Our client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Remote location.
 
Responsibilities:
  • Help us elevate our patient care to a whole new level! Join our client team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models.
  • You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.
  • With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs.
  • Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
  • 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
  • Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
  • Provides evidence-based disease management education and support to help the member achieve health goals.
  • Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
  • Provides care coordination to support a seamless health care experience for the member.
  • Meticulous documentation of care management activity in the member’s electronic health record.
  • Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
  • Identifies and connects members with health plan benefits and community resources.
  • Meets regulatory requirements within specified timelines.
  • The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
  • Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members.
  • This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.
  • Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
  • Conduct oneself with integrity, professionalism, and self-direction.
  • Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
  • Familiarity with community resources and services.
  • Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
  • Maintain strong collaborative and professional relationships with members and colleagues.
  • Communicate effectively, both verbally and in writing.
  • Excellent customer service and engagement skills.
  • The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
 
Requirements:
  • Verifiable High School Diploma or GED Required:
  • Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY. Additional licensure is preferred but not required. NY is not a compact state, single state licensure for NY is required.
  • Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
  • Access to a private, dedicated space to conduct work effectively to meet The requirements of the position.
  • Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
  • Minimum 3+ years of nursing experience
  • Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience
  • Experience providing care management for Medicare and/or Medicaid members.
  • Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
  • Experience conducting health-related assessments and facilitating the care planning process.
  • Bilingual skills, especially English Spanish, preferred not required
  • Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
  • Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY.
  • Additional licensure is preferred but not required.
  • NY is not a compact state, single state licensure for NY is required.
 
Why Should You Apply?