Care Manager (RN)

Description

What You'll Do

• Identifies appropriate patients for care management and performs outbound calls to assign high risk or chronic care managed patients
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment 
• Develop Initial Care Plan (ICP) by conditions identified in HRA, patient assessment, medical records authorizations/referrals, primary care physician, member and Interdisciplinary Team
• Sets patient prioritized self-management goals. 
• Create cares in the care management platform for each patient under care management with appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits etc
• Coordinates care plan and/or assessment findings with health plan care managers, as appropriate
• Manages a panel/caseload of 75 - 100 chronic and high-risk patients in collaboration with Nurse Practitioner, Pharmacist, PCP, specialists and other ICT members. Meets assigned/expected patient contacts daily to assess and coordinate care. Interfaces with Medical Director and attends and participates in Interdisciplinary Rounds
• Collaborates and coordinates care with health plans, Community Based Programs,
  Palliative Care and Behavioral Health providers as appropriate. Collaborates with patient’s family and physicians for seamless coordination of care and services
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary to meet health plans and national standards (i.e., NCQA requirements) for turn-around-time for assessments, care plans and IDTs
• Other duties as assigned

Qualifications

• Bachelor of Science in Nursing (BSN) preferred; Associate degree in Nursing required
• Rhode Island RN unrestricted active license
• At least 2 years of clinical nursing experience (case management, acute care, medical group, health plan, or managed care preferred)
• Certifications & Licensure Active, unrestricted Registered Nurse (RN) license
• Strong clinical background must be familiar with developing care plans and assessments
• Experience with Microsoft Office Word
• Understanding of regulatory standards (CMS, NCQA, etc.). Ability to assess and manage complex clinical and psychosocial situations
• Excellent communication, collaboration, and critical-thinking skills
• Proficiency in electronic health records (EHR) and care management documentation systems
• Ability to manage multiple priorities in a fast-paced environment

• Able to work independently and make independent decisions
• Ability to work prioritize and multi-task
• Excellent written and verbal communication skills
• Maintain courteous professional attitude when working with internal and external customers
• Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements

Environmental Job Requirements and Working Conditions

• This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis.  The home office is located at 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919.
• This position requires up occasional travel for onsite visits or team meetings.
• The target pay range for this role is between $40.00 - $48.00 per hour.  Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.