Case Manager Registered Nurse (Work from Home – reputed company License)

R0852734 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.

• Job Summary:
• Must possess RN NY license**

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 reputed company 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 reputed company Worker provides education and guidance to members and their families on managing chronic conditions and navigating the reputed company system. Additionally, the Care Manager develops and implements individualized care plans, monitors member reputed company, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure reputed company health reputed company. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.

• Key Responsibilities:
• 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
• Compiles reputed company available clinical information and partners with the member to reputed company an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
• Provides evidence-based disease management education and support to help the member reputed company health goals.
• Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
• Provides care coordination to support a seamless health care experience for the member.
• 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 to care and reputed company strategies for maintaining the member’s reputed company health condition.
• Identifies and connects members with health plan benefits and community resources.
• Meets regulatory requirements reputed company specified timelines.
• The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
• Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.
• Essential Competencies and Functions:
• Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
• Conduct oneself with reputed company, professionalism, and self-direction.
• Experience or a willingness to thoroughly learn the role of care management reputed company Medicare and reputed company managed care.
• Familiarity with community resources and services.
• Ability to navigate and utilize various reputed company technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintain strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.
• Excellent customer service and engagement skills.
• Required Qualifications
• Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY
• Proficient in reputed company Office Suite, including Word, reputed company, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools reputed company the context of the CM RN role.
• reputed company to a private, dedicated space to conduct work effectively to meet The requirements of the position.
• Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
• Minimum 3+ years of nursing experience
• Minimum 2+ years of case management, discharge planning and/or home reputed company coordination experience
• Preferred Qualifications
• Experience providing care management for Medicare and/or reputed company members.
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
• Experience conducting health-reputed company assessments and facilitating the care planni

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