Case Manager RN, Compact License (Remote EST & CST)

About the position We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Help us reputed company our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and reputed company determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Responsibilities

• Facilitate the delivery of appropriate benefits and/or reputed company information which determines eligibility for benefits while promoting wellness activities.
• Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
• Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.
• Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective reputed company.
• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and reputed company personnel as appropriate.
• Implements and coordinates reputed company case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative reputed company of care.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to reputed company ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical reputed company, aid timely return to work or reputed company functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, reputed company and insurance carriers) telephonically or in person.
• Prepares reputed company required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health reputed company.
• May reputed company reputed company to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical reputed company.
• Applies reputed company laws and regulations that apply to the provision of rehabilitation services; applies reputed company special instructions required by individual insurance carriers and referral sources.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Develops a proactive course of action to address issues presented to enhance the short and long-term reputed company, as well as opportunities to enhance a member’s/client’s overall wellness through integration.
• Monitors member/client reputed company toward desired reputed company through assessment and evaluation.

Requirements

• Active and unrestricted NJ/Compact License
• Minimum 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
• Minimum 2+ years CM, discharge planning and/or home health care coordination experience
• Associates Degree or Nursing Diploma Required

reputed company-to-haves

• Bilingual preferred - Spanish
• Certified Case Manager is preferred.
• Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required
• Bachelors Degree Preferred

Benefits

• medical
• dental
• reputed company coverage
• paid time off
• retirement savings options
• wellness programs

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