Care Manager II RN

Job Title: Care Manager II (RN)

Duration: 12 months (Possible Extension)

Location: Remote (MRSA Central area Texas)

Shift: Day 5x8Hour (08:00 05:00)

Notes:

• This is a remote field position.
• Care Managers will be working in the field 4 days per week doing assessments.
• 1 day per week will be working on documentation in a remote home office.
• Candidates will need to be able to drive self in a personal vehicle to the members homes.
• Travel will include the following counties: Dallas Collin Rockwall Hunt Navarro Kaufmann Ellis.

Job Summary:

• Walk me through the daytoday responsibilities of this the role and a description of the project.
• Potential for facetoface assessments in member homes within the Dallas SDA Dallas Collin Rockwall Hunt Ellis Navarro Kaufman counties as scheduled.
• Complete all documentation in the electronic health record; referrals for items/services coordination of care.
• Following up on members in the upgrade process to implement services.
• Making outbound phone calls to members and providers to coordinate services.
• Describe the performance expectations/metrics for this individual and their team:
• Need to be able to use Excel use spreadsheets to determine productivity.
• Must be able to use telephone and Microsoft Office Outlook is a plus because they are coordinating member services.
• Candidates need WiFi at their home during WFH.
• Will be flexible assignments will be based on business needs.
• Tell me about what their first day looks like:
• Meeting at 830 am for virtual office set up with the service desk.
• TEAMs Meeting with management team following system setup.
• Working independently on learning modules and obtaining RUG certification.

Position Purpose:

• Perform care management duties to assess plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality cost effective care.

Responsibilities:

• Assess the members current health status resource utilization past and present treatment plan and services prognosis short and longterm goals treatment and provider options.
• Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives goals and interventions designed to meet members needs and promote desired outcomes.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased organizations medical care and other services to support the members overall care management plan.
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Case load will reflect heavier weighting of complex cases than Care Manager I commensurate with experience.
• Enter and maintain assessments authorizations and pertinent clinical information into various medical management systems.
• Direct care to participating network providers.
• Perform duties independently demonstrating advanced understanding of complex care management principles.
• Participate in case management committees and work on special projects related to case management as needed.

Education/Experience:

• Graduate from an Accredited School of Nursing. Bachelors degree in Nursing preferred.
• 2 years of clinical nursing experience in a clinical acute care or community setting and 1 years of case management experience in a managed care setting.
• Knowledge of utilization management principles and healthcare managed care.
• Experience with medical decision support tools (i.e. InterQual NCCN) and government sponsored managed care programs.

Licenses/Certifications:

• Current states RN license

DaytoDay responsibilities:

• Review/research assigned members.
• Contact the member the day before to confirm visit and set up telehealth meeting invite.
• Explain to members that the visit may take anywhere between 23 hours.
• Perform assessment either via telehealth (video AND audio) or inperson (in members home)
• Contact PCP office to confirm diagnosis and report any abnormal findings.
• Upload the MN signature page within 1 business day for attempts to MD signature to begin.
• Complete the assessment documentation.
• Coordinate assessment finding needs exsend referrals for DME items covered under the members core benefit initiate nonwaiver items/services.
• Once the MD signature is receivedassessing RN is to sign the MNLOC (assessment) within 24 hours.
• Process continues from this point as needed.

Requirements:

Education/Experience:

• Graduate from an Accredited School of Nursing.
• Bachelors degree in Nursing preferred. 2 years of clinical nursing or case management experience in a clinical acute care managed care or community setting. 2 years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
• Experience with medical decision support tools (i.e. InterQual NCCN) and government sponsored managed care programs.
• Other state specific requirements may apply.

Licenses/Certifications:

• Current states RN license.