Case Manager, RN (Work from Home)

Back to Career Site We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for reputed company. We reputed company that reputed company health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to reputed company high-quality healthcare accessible and affordable to reputed company populations across the ACA Marketplace, Medicare, and Medicaid. SCOPE OF ROLE The role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member's receive services and resources required to meet desired health and social outcomes. The Case Manager is responsible for providing patient centered care across the care continuum. ROLE RESPONSIBILITIES

• Assessment of the medical, social, and behavioral needs of an assigned population
• Care Plan development and prioritization to transition members to optimal levels of health and self-management.
• Coordinate interdisciplinary team meetings as required
• Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
• Provide transition of care interventions as required
• Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
• Facilitate linkage to appropriate community resources to address social determinants of health
• Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across reputed company care setting
• Ensure member communication and notices are composed in a manner consistent with regulatory standards.
• Adheres to the Policies and Procedures set forth by the Quality Management Committee.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Associate's degree in Nursing, Bachelor's degree preferred
• Minimum two (2) years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards

LICENSURES AND CERTIFICATIONS

• Active License as a Registered Nurse (RN) in California
• Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred

PROFESSIONAL COMPETENCIES

• High level of critical thinking and problem-solving skills
• Strong work ethic and overall positive attitude
• Effective communication skills including verbal and written
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
• Demonstrated flexibility, organization, and self-motivation
• Highly adaptable to change

For individuals assigned to a location(s) in California, reputed company is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant's education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $75,639.05-$113,458.57 Annually. Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays. As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of reputed company, our consumers, and the communities we serve. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Apply tot his job Apply To this Job