RN Level 2

Pay Range - $38/hr. to $40/hr. on w2

Description

Responsible for performing care coordination duties using established guidelines to ensure the appropriate level of care and facilitate transition across the continuum of care for specialty populations. This position implements interventions to promote efficient utilization of healthcare benefits and resources.

Job Responsibilities

• Assess members clinical needs in accordance with established guidelines and standards for specialty population members.

• Implement the delivery of high-quality, cost-effective care based on a customized population model of care and clinical practice guidelines established by the health plan.

• Partner with members and their families, physicians, and healthcare team members to ensure that member needs are met both within and outside the organization.

• Advocate for members across various care settings and coordinate appropriate resource utilization.

• Utilize the care management process to set priorities, plan, organize, and implement goal-directed interventions that promote self-care and transition members toward independent status.

• Ensure appropriate care for mandated non-compliant members through ongoing monitoring of utilization and care needs.

• Document care accurately and comprehensively in accordance with standards of practice and current organizational policies.

• Evaluate care by identifying and resolving problems, analyzing variances, and participating in quality improvement initiatives to enhance member outcomes.

• Monitor members care activities and outcomes across all sites of service, regardless of network participation, to ensure appropriateness and effectiveness.

• Consult with internal stakeholders regarding complex cases and escalate issues to internal physician resources as appropriate.

• Perform other duties and responsibilities as assigned by management.

Disclaimer

This job summary is intended to describe the general nature and level of work performed by colleagues within this classification. It is not intended to be a comprehensive inventory of all duties, responsibilities, or qualifications required of colleagues assigned to this position.

Education and Experience

• Current license as a Registered Nurse (RN), or a bachelor s degree in Social Work, Health Science, Behavioral Science, or a related field.

• Graduate-level degree in Social Work, Health Science, or Behavioral Science preferred.

• Minimum of three (3) years of experience serving members with special needs.

Knowledge

• Strong knowledge of professional standards of practice for case management.

• Strong knowledge of managed care principles.

• Strong knowledge of specialty populations, as applicable.

Skills and Abilities

• Strong organizational and time-management skills.

• Excellent oral and written communication skills.

• Proficiency with personal computers and Microsoft Office applications, including Excel, Access, and Word.

• Strong problem-solving, critical-thinking, and conflict-resolution skills.