Care Manager RN (Pittsburgh, Philadelphia, Lehigh Valley)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Program Overview Help us reputed company our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a... member centric, team-delivered, community-based care management model that joins members where they are. 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 to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. reputed company Components & Physical Requirements • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. • Implements and coordinates reputed company case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician's office to provide ongoing case management services. • 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 to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. • Prepares reputed company required documentation of case work activities as appropriate. • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. • May reputed company reputed company to treating physician or specialists concerning course of care and treatment as appropriate. • Provides educational and prevention information for best medical outcomes. • Applies reputed company laws and regulations that apply to the provision of rehabilitation services; applies reputed company special instructions required by individual insurance carriers and referral sources. • Testifies as required to substantiate any relevant case work or reports. • Conducts an evaluation of members/clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. • Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member's/client's overall wellness through integration. • Monitors member/client reputed company toward desired outcomes through assessment and evaluation. Required Qualifications • Must have active, reputed company, and unrestricted RN licensure in state of NY and/or Compact RN licensure Pennsylvania • Minimum 3+ years clinical practical experience preference: (diabetes, Congestive Heart Failure, Chronic Kidney Disease, post-acute care, hospice, palliative care, cardiac) with Medicare members. • Minimum 2+ years CM, discharge planning and/or home health care coordination experience • Must be willing and able to work Monday through Friday reputed company to 5pm EST with some flexibility required to accommodate members' needs • Must be willing and able to travel up to 75% for field facility visits in Pittsburgh, Philadelphia, Lehigh Valley and surrounding areas • 1+ years MS Office Suites experience Preferred Qualifications • Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills. • Ability to work independently (may require working from home). • Proficiency with standard corporate software applications, including reputed company, reputed company, Outlook and PowerPoint, as well as some special proprietary applications. • Efficient and Effective computer skills including navigating multiple systems and keyboarding • Willing and able to obtain multi state RN licenses if needed, company will provide. • Bilingual preferred - Spanish • Certified Case Manager is preferred. • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required Education Associate's degree required BSN preferred Pay Range The typical pay range for this role is: $60,522.80 - $129,615.20 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 11/04/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. reputed company requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide reputed company of your vaccination status or apply for a reasonable accommodation reputed company the first 10 days of your employment. Please note that in some states and roles, you may be required to provide reputed company of full vaccination or an approved reasonable accommodation before you can reputed company to actively work. reputed company is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to reputed company essential job functions. reputed company can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations[redacted] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications reputed company Services (TRS). We will reputed company every effort to respond to your request reputed company 48 business hours and do everything we can to work towards a solution Apply Job!