RN Care Manager

RN Care Manager

Requirements

• Registered Nurse with a current unrestricted multi-state compact license or willingness to pursue
• Bachelor of Science in Nursing
• 3+ years nursing experience
• 2+ years of case management and/or utilization management

Responsibilities

• Performs within licensed scope of nursing practice and under the direction of the Sr. Director, Clinical Services
• Identifies, screens, and enrolls members meeting criteria into Care Management Services
• Educates members and providers (as appropriate) regarding the Medi-Share provisions and processes
• Confirms member’s condition and plan of care are eligible for sharing based on Medi-Share and FDA/CMS approved evidence-based clinical management guidelines; suggests resources for those conditions/plan of care not eligible for sharing
• Identifies, educates, and facilitates member participation in appropriate member stewardship including, but not limited to patient assistance programs for medication, laboratory, and genetic testing
• Provides disease/condition specific clinical education to include multimedia resources, if available
• Identifies opportunities for and facilitates transitional care
• Partners with organizational resources to facilitate effective and cost-efficient outcomes for members
• Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
• Documents case work, all telephone conversations, correspondence, and tasks completely and accurately in appropriate IT systems
• Maintains and independently manages assigned caseload and departmental workflows within agreed service levels
• Presents accurate, complete, and concise case information to Sr. Director, Clinical Services within agreed upon service levels
• Completes medically related special projects independently as assigned with minimal supervision
• Attends all required departmental and organizational meetings
• Prays with members and providers as appropriate
• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
• Perform all other duties as assigned

Preferred Qualifications

• Nurse coaching experience
• Transitional care and transplant clinical experience
• Have or willing to obtain a certification in either case management or managed care nursing within two years