Description:

Government Programs Care Manager III. For this position, formerly Nurse Case Management Senior Analyst, through the care management process, will promote the improvement of health outcomes to SNP members. Also assist those members experiencing the burdens of illness and injury. The Care Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case load assignments of a defined population.

The Care Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced.
Ability to work independently and effectively communicate to internal and external customers in a telephonic environment.

Responsibilities:
Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes.
Promote consumerism through education and health advocacy.
Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric care management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
Implements, coordinates, monitor and evaluate the care management plan on an ongoing, appropriate basis.
Adheres to professional practice within scope of licensure and certification quality assurance standards and all care management policy and procedures.
Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
Demonstrates sensitivity to culturally diverse situations, clients and customers.

All care management activities and performance metrics are monitored.


Minimum requirements:
Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Compact RN license a required for this role.
Two years full-time equivalent of direct clinical care to the consumer.


Notes:
40 hour schedule that supports M-F, 8 working hours each work day (exclusion of company holidays)
can be remote in any state except NY, CA, HI or AK