Case Manager, RN

CAI

Job ID Number

Employment Type

Worksite Flexibility

Job Summary

Job Description

We are looking for a Case Manager, RN to provide telephonic care and support in the assessment, planning, coordination, monitoring, and evaluation of services to healthcare members. This position will be contract and remote.

Due to the specific legal and contractual requirements associated with this position, only US Citizens will be considered for this role.

What You’ll Do

• Communicate effectively while performing customer telephonic interviewing and communication with external contacts. (apply basic motivational interviewing skills)

• Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts

• Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States

• Educate members, (with approved websites including Healthwise connect) in order to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes

• Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care

• Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs

• Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member

• Develop an individualized plan of care designed to meet the specific needs of each member

• Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated

• Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services

• Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention in order to develop a realistic plan of care

• Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination

• Maintain a working knowledge of available community resources available to assist members

• Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible

• Work within a Team Environment

• Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services in order to enhance professional knowledge and competency for overall management of members

• Participate in departmental and/or organizational work and quality initiative teams

• Case collaborate with peers, Case Management Specialists, Management Team, Physician Advisors, and other interdepartmental contacts

• Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources

• Foster effective work relationships through conflict resolution and constructive feedback skills

• Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable

• Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served in order to foster constructive and collaborative solutions to meet member needs

• Other duties as assigned or requested

What You’ll Need

Required:

• Bachelor’s degree in nursing or RN certification and 3 years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations

• 3-5 years of experience in working in Acute Care/Managed Care

• Telephonic case management experience

Preferred:

• Bilingual English/Spanish language skills

• Case Management Certification

Physical Demands

• Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state and local standards.

• Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc.

• Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard and monitor.

#LI-AE1

The pay range for this position is $40.00- $43.00per hour (USD). Exact compensation may vary based on several factors, including location, experience, and education. Benefit packages for this role includes medical, dental, and vision insurance, as well as 401k retirement account access. Employees in this role may also be entitled to paid sick leave as provided by applicable law.

Reasonable Accommodation Statement

If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to or (888) 824 – 8111.

Equal Employment Opportunity Policy Statement

CAI is committed to equal employment opportunity. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. All employment decisions are based on valid job requirements, including hiring, promotion, and compensation. Harassment and retaliation are prohibited.