RN (Registered Nurse)

Job Title: RN (Registered Nurse) Case Manager

Location: Remote

Duration: 12 months

Description:

• The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic person centric care management program to a diverse health plan population with a variety of health and social needs.
• They serve as the single point of contact for members caregivers and providers using a variety of communication channels including phone calls emails text messages and the Client online messaging platform.
• The Case Manager RN uses the case management process to assess develop implement monitor and evaluate care plans designed to optimize the members health across the care continuum.
• They work in partnership with the member providers of care and community resources to develop and implement the plan of care and achieve stated goals.

Essential duties and responsibilities:

• Lead the coordination of a regionally aligned multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioural Health Social Workers Registered Dietitians Pharmacists Clinical Support Staff and Medical Directors.
• Use the case management process to assess develop implement monitor and evaluate care plans designed to optimize the members health across the care continuum.
• Assess the members health psychosocial needs cultural preferences and support systems.
• Engage the member and/or caregiver to develop an individualized plan of care address barriers identify gaps in care and promotes improved overall health outcomes.
• Arrange resources necessary to meet identified needs (e.g. community resources mental health services substance abuse services financial support services and disease-specific services).
• Coordinate care delivery and support among member support systems including providers community-based agencies and family.
• Advocate for members and promote self-advocacy.
• Deliver education to include health literacy self-management skills medication plans and nutrition.
• Monitor and evaluate effectiveness of the care management plan assess adherence to care plan to ensure progress to goals and adjust and revaluate as necessary.
• Accurately document interactions that support management of the member.
• Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
• Educate the member and/or caregiver about post-transition care and needed follow-up summarizing what happened during an episode of care.
• Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
• Adhere to professional standards as outlined by protocols rules and guidelines meeting quality and production goals.
• Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).

Education and Experience

• Nursing Diploma or Associates degree in nursing required.
• Bachelors degree in nursing strongly preferred.
• 3 years of clinical nursing experience in a clinical acute/post-acute care and community setting required.
• 1 year of case management experience in a managed care setting strongly preferred.
• Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.

Certificates Licenses Registrations

• Current active and unrestricted Multistate Compact Registered Nurse license required
• Certification in Chronic Care Professional (CCP) and Certification in Case Management (CCM) preferred QUALIFICATIONS
• To perform this job successfully an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge skill and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Skills and Abilities

• Ability to think critically be decisive and problem solve a variety of topics that can impact a members outcomes.
• Empathetic supportive and a good listener.
• Proficient in motivational interviewing skills.
• Demonstrated time management skills.
• Organizational skills with the ability to manage multiple systems/tools while simultaneously interacting with a member.
• Must have intermediate computer knowledge typing capability and proficiency in Microsoft programs (Excel OneNote Outlook Teams Word etc.).
• Must embrace teamwork but can also work independently.
• Excellent interpersonal and communication skills both written and verbal.

Additional experience:

• Maternity NICU Mother/Baby and/or Labour and Delivery experience that also carries a Multistate nursing compact license.