Complex Case Manager Rn (Medical)

TL;DR

Complex Case Manager RN (Medical): Managing a panel of members with varying health statuses and clinical needs, identifying appropriate clinical interventions, and coordinating care. Focus on developing care plans, addressing barriers to care, and improving health outcomes for members.

Location: Must have Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.

Company

hirify.global prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibits discrimination against all individuals based on any category protected by applicable federal, state, or local law.

What you will do

• Perform ongoing assessment of members’ health management needs.
• Identify the right clinical interventions to address member needs and triage members to appropriate resources for additional support.
• Create care plans to address members’ identified needs, remove barriers to care, and identify resources.
• Help improve the health outcomes of members.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
• Maintain current knowledge and adhere to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management.

Requirements

• High School Diploma/GED.
• 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience.
• Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.
• Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion.
• Broad knowledge of disease processes.
• Understanding of healthcare costs and the broader healthcare service delivery system.

Nice to have

• Bachelor's Degree in Nursing.
• Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT).
• Experience working with the healthcare needs of diverse populations.
• Understanding of the importance of cultural competency in addressing targeted populations.
• Certification in Case Management.

Culture & Benefits

• Ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
• Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.
• Comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
• Comply with the company’s Code of Business Conduct.