This job is archived
(Archived) Registered Nurse RN Case Manager - Full time
Job Description
Registered Nurse RN Case Manager - Full time
This is an on-site role in Boston MA. This work is mostly in
person with some travel. 4 days in the field and flexible scheduling.
§ Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting.
§ Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options
§ Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members
§ Routinely follows up with member as scheduled to assess progress towards goals
§ Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals
§ Provide patient-centered intervention; such as making and verifying appointments, performing medication and care compliance initiatives;.
§ Communicates Member health updates from Care Team to RP/POAs.
§ Coordinates with the Care Team for non-urgent health or clinical questions.
§ Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues.
§ Updates Member and RP/POA contact information such as changes of address, email, or phone numbers.
§ Actively supports Account Manager in identifying and securing contracts with "preferred" Providers.
§ Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments.
§ Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.
§ Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team.
§ Ensures documentation of care team meetings and transmits to Plan.
§ Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members.
§ Monitors midnight reports/community census to help identify member transitions to hospital or other care levels.
Education &
Experience
§ Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred.
§ One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
§ Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
§ Case management certification preferred.