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The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.
Job Responsibility:
50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care
Compiles all available clinical information and partners with the member to develop an individualized care plan
Provides evidence-based disease management education and support
Ensure the appropriate members of the interdisciplinary care team are involved
Provides care coordination to support a seamless health care experience
Meticulous documentation of care management activity in the member’s electronic health record
Collaborate with other participants of the Interdisciplinary Care Team to address barriers
Identifies and connects members with health plan benefits and community resources
Meets regulatory requirements within specified timelines
Supports other members of the Care Team through clinical decision making and guidance
Additional responsibilities as assigned by leadership
Requirements:
Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence
Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams
Access to a private, dedicated space to conduct work effectively
Dependents must have separate care arrangements during work hours
Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually
3+ years of nursing experience
2+ years of case management, discharge planning and/or home healthcare coordination experience
Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field
Nice to have:
Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning process
Bilingual skills, especially English-Spanish
Bachelor’s of Science in Nursing (BSN)
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching