Care Manager (RN)

Summary:

• Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes.
• Includes personalized care plans and education for members and their families.

Responsibilities:

• Evaluate the needs of the member, barriers to accessing appropriate care, and social determinants of health needs, focusing on member-identified priorities.
• Develop ongoing care plans and collaborate with providers to identify resources to address unmet needs.
• Identify problems/barriers to care and provide appropriate care management interventions.
• Coordinate between the member, family/caregivers, and care provider team to ensure adequate and appropriate person-centered care.
• Provide ongoing follow-up and monitoring of member status, condition changes, and progress towards care plan goals.
• Provide resource support for local services (e.g., employment, housing, independent living) based on assessment and plans.
• Facilitate care management and collaborate with providers or specialists to ensure timely access to needed care.
• Perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
• Collect, document, and maintain member information and care management activities to ensure compliance with regulations.
• Provide education to members and their families/caregivers on disease processes, resolving care gaps, and healthcare benefits.
• Provide feedback to leadership on opportunities to improve care and quality delivery for members in a cost-effective manner.
• Comply with all policies and standards.

Requirements:

• Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing.
• Minimum 2 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

Preferred Skills:

• For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL.
• For Sunshine Health (FL) Only: Minimum of two years of pediatric experience. May require up to 80% local travel.