Community Care Case Manager

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

As a Community Care Case Manager, you will use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet an individual's and family's comprehensive health needs.

Responsibilities

• Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care.
• Interacts with members/clients telephonically or in person.
• Assesses and analyzes injured, acute, or chronically ill members/clients' medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management.
• Communicates with member/client and other stakeholders as appropriate.
• Prepares all required documentation of case work activities.
• Interacts and consults with internal multidisciplinary team as indicated.
• May make outreach to treating physician or specialists concerning course of care and treatment.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services.
• Testifies as required to substantiate any relevant case work or reports.
• Conducts an evaluation of members/clients' needs and benefit plan eligibility.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimizes overall wellness and medical outcomes, and aids timely return to work or optimal functioning.
• Develops a proactive course of action to address issues presented.
• Monitors member/client progress toward desired outcomes.

Required Qualifications

• Candidate must reside in the South Region: OH, VA, NC, KY, TN, SC, GA, AL, MS, AR, LA, FL.
• Candidate must have active and unrestricted Compact Registered Nurse (RN) Licensure in OH or in their state of residence.
• 3+ years clinical practical experience with Medicare members.
• 2+ years case management, discharge planning and/or home health care coordination experience.

Preferred Qualifications

• Bilingual - Spanish.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently.
• Willing and able to obtain multi-state Registered Nurse (RN) licenses if needed.
• National professional certification (CRC, CDMS, CRRN, COHN, or CCM).

Education

• Associate's Degree or Nursing Diploma (REQUIRED).
• Bachelor's Degree (PREFERRED).

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.