Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. As a Community Care Case Manager, you will have a life-changing impact on our Community Care members.
Responsibilities:
- Acts as a liaison with members, families, employers, providers, insurance companies, and healthcare personnel.
- Implements and coordinates case management activities for catastrophic cases and chronically ill members.
- Interacts with members telephonically or in person, providing ongoing case management services.
- Assesses and analyzes members' medical and vocational status, developing plans of care to optimize wellness and medical outcomes.
- Communicates with stakeholders, including medical providers, attorneys, employers, and insurance carriers.
- Prepares required documentation of case work activities.
- Interacts and consults with internal multidisciplinary teams to maximize best health outcomes.
- May make outreach to treating physicians or specialists concerning courses of care and treatment.
- Provides educational and prevention information for best medical outcomes.
- Applies laws and regulations related to rehabilitation services.
- Conducts evaluations of members' needs and benefit plan eligibility.
- Utilizes case management processes in compliance with regulatory and company policies.
Requirements:
- Active and unrestricted Compact Registered Nurse (RN) Licensure in Alabama, Arkansas, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Georgia, or Florida.
- 3+ years of clinical practical experience, preferably in diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or Home Health with Medicare members.
- 2+ years of case management, discharge planning, or home health care coordination experience.
- Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint.
- Ability to work in a fast-paced, high-volume environment with strong time management and prioritization skills.
Preferred Qualifications:
- Bilingual - Spanish.
- Excellent analytical and problem-solving skills.
- Effective communications, organizational, and interpersonal skills.
- Certified Case Manager.
- National professional certification (CRC, CDMS, CRRN, COHN, or CCM).
Education:
- Associate's Degree in Nursing or Nursing Diploma (required).
- Bachelor's Degree in Nursing (preferred).
Work from Home Requirements:
- Direct/hardwired internet connection to a modem/router within 7 feet of computer.
- Quiet, secure, and private designated home virtual work location.
- Work-from-Home colleagues must work within the state and city where they currently live.
Technical and Logistical Requirements:
- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
- Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
- Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.
- Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.
- Ability to resolve common technical issues independently.
Anticipated Weekly Hours: 40
Time Type: Full-time
Pay Range: $54,095.00 - $116,760.00