Centers for Medicare and Medicaid Services (CMS), Consulting, Disease, Establish Priorities, Health Plan, Healthcare, Healthcare Providers, Identify Issues, Leadership, Maintain Compliance, Member Orientation, Needs Assessment, Nursing, Nursing Credentials, Pediatrics, Registered Nurse (RN), Regulations, Third-Party Payer, Time Management, Willing to Travel
Summary:
- Contract Type: Contract to Hire
- Work Mode: Field Worker
Responsibilities:
- Evaluate the needs of the member, barriers to accessing appropriate care, and social determinants of health needs, focusing on what the member identifies as a priority.
- Develop ongoing care plans/service plans and collaborate with providers to identify resources to address member's unmet needs.
- Identify problems/barriers to care and provide appropriate care management interventions.
- Coordinate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
- Provide ongoing follow-up and monitoring of member status, changes in condition, and progress towards care plan/service plan goals.
- Provide resource support to members and care managers for local resources for various services based on service assessment and plans, as appropriate.
- Facilitate care management and collaborate with appropriate providers or specialists to ensure timely access to needed care or services.
- Perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
- Collect, document, and maintain all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations.
- Provide and/or facilitate education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
- Provide feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
- Perform other duties as assigned.
- 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.
- For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL.
- For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel.
A
Axelon Services Corporation