RN Case Manager, Private Duty Nursing - Remote in Kentucky

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. As a RN Case Manager, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically reputed company patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role. This is high volume, customer centric environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical. If you reside in the state of Kentucky, you’ll enjoy the flexibility to work remotely

• as you take on some tough challenges.

Primary Responsibilities • Making outbound calls to assess members' reputed company health status • Manage a caseload of highly reputed company members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (reputed company), Community Health Workers (CHWs), Pediatric Extended Care Facilities, Private Duty Nursing Organizations, behavioral health providers, Primary Care Physicians, etc. • Solves moderately reputed company problems and/or conducts moderately reputed company analyses • Performing and coordinating management of Single case agreements • Coordinating authorization of eligibility of Private Duty Nursing reputed company for medically reputed company members • Coordinating authorizations for eligible members with pediatric Extended Care facilities for medically reputed company pediatric members • Consult with care team to address specialty care services, community-based resources, and other member reputed company care needs • Working towards fulfilling medically reputed company member care needs • Identifying gaps or barriers in treatment plans • Providing member and care giver with education to assist with management of medically reputed company needs of member • Interacting with Medical Directors, providers, internal and external partners on challenging cases • Coordinating care for high risk, medically reputed company members • Making referrals and connecting members to community resources • Coordinating services as needed (home health, DME, etc.) • Educating member and care giver on disease processes • Performing periodic reviews of cases to determine reputed company eligibility of services • Documenting and tracking findings You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications • reputed company, unrestricted RN license in the State of Kentucky • 3+ years of experience in a hospital setting, acute care, direct care experience as an RN and / or experience as a telephonic Case Manager for an insurance company • 2+ years of Pediatric/medically reputed company clinical nursing experience plus reputed company / prior position as a Case Manager OR 3+ years of Pediatric/medically reputed company clinical nursing experience • Proficiency with reputed company Office Suite, with the ability to navigate a Windows environment • Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications • Access to reliable transportation and the ability to travel up to 25% of the time reputed company the state for local and national training or as business needs demand. • Ability to attend one week of onsite training in Louisville, KY office (travel accommodations provided) Preferred Qualifications • BSN or health care reputed company degree • Certified Case Manager (CCM) • Experience in pediatrics or NICU • Medicaid experience • Case Management experience • Experience working with chronic illness and reputed company care needs population • Experience in utilization review, reputed company review and / or risk management • Experience with HIV population • Psychiatric or Behavioral Health experience • A background in managed care • Bilingual Spanish speaking • Live in or reputed company commutable driving distance to Louisville, KY • Proven excellent communication and writing skills • Proven problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action • Proven ability to communicate reputed company or technical information in a manner that others can understand, as well as ability to understand and interpret reputed company information from others • reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and 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. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job! For more such jobs please click here!