RN Case Manager or LCSW-C

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Make It Happen At Hopkins!

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine one of the premier health delivery academic and research institutions in the United is a $2.5B business serving over 400000 lives with lines of business in Medicaid Medicare commercial military health health solutions and venture has become a leader in provider-sponsored health plans and is poised for future growth.

About this position:

Work Schedule: Monday - Friday the core business hours are 8:00 AM - 5:00 PM

What awaits you:

• Work-life balance -This is a remote role.
• Medical Dental and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Generous Paid Time Off
• Health and wellness programs and MORE!

Who you are:

The Case Manager anticipates and coordinates care/services/health education for targeted DSNP member populations with chronic disease conditions or high-cost specialty care. She/he demonstrates knowledge of case and disease management prognosis and outcomes and is responsible for ensuring that member goals are achieved within a specified time period based upon individual needs reasonable expectations and well-documented outcomes. The ideal candidate brings working knowledge of CMS regulations and a strong commitment to following our Model of Care (MOC) including active participation in the annual MOC audit process and weekly MOC audit activities. Were looking for someone with a genuine passion for working alongside a cohesive empathetic team kind like-minded professionals who care about our members and about each other.

What youll do:

• Identifies and acts upon impending changes in member condition.
• Identifies and analyzes staff/member/system issues that impact the plan of care.
• Initiates corrective action.
• Reviews/interprets member population-specific financial reports.
• Maintains budgeted caseload
• Makes decisions regarding work processes based on established guidelines.
• Understands and uses principles of negotiation.
• Effectively uses resources within control.
• May assign work to support staff

What youll bring:

• Demonstrated clinical expertise in acute care nursing with clinical expertise in a specialty area preferred.
• Knowledge of health care and managed care delivery systems.
• Standards of medical practice.
• Insurance benefit structures and related legal/ medical issues.
• Utilization management and quality improvement processes.
• Community resources.
• Ability to work in a dynamic team-oriented environment and demonstrate positive relationship building.
• Effective verbal/ written communication.
• Ability to affect change.
• Ability to perform critical analysis plan and organize effectively.
• Ability to promote member/family autonomy.
• Business acumen so that health benefits and member/provider satisfaction are maximized while solidifying the programs viabilitythrough cost effective intervention.

Education:

• Bachelors degree in nursing or related years of experience or MSW in social work preferred.

Work Experience:

• Minimum five (5) years clinical practice.
• Minimum three (3) years clinical practice in a specific specialty.
• Additional case management/ disease management or managed care experience preferred.

Licensure:

• Current registered nurse licensure in the state of Maryland or LCSW-C.
• Certification in case management (CCM) preferred.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500000 active members with lines of business in Medicaid Medicare commercial military health health solutions and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare at Johns Hopkins Health Plans we are setting the pace for change within the healthcare industry. We develop innovative analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

Salary Range: Minimum 43.61/hour - Maximum 67.59/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount salary discussions will occur during candidate screening calls before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment where we embrace and celebrate our differences where all employees feel valued contribute to our mission of serving the community and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity and expression age national origin mental or physical disability genetic information veteran status or any other status protected by federal state or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.