Care Manager (RN)
About The Position
The Care Manager will be responsible for enrolling members in case management and completing required care management activities for individuals of all ages. The role requires strong communication, organization, and care coordination skills to ensure members receive appropriate support based on their individual needs. Candidates must reside in Kansas, with a strong preference for individuals who live in or near the northwest Kansas service area. The primary service area includes Hamilton, Kearny, Finney, Hodgeman, Pawnee, Stanton, Grant, Haskell, Gray, Ford, Edwards, Stafford, Morton, Stevens, Seward, Meade, Clark, Kiowa, Pratt, Comanche, and Barber counties. This position requires approximately 50% travel throughout the assigned service area. Care Managers must be comfortable driving throughout the region and completing in-home visits based on member needs and availability. The position is not fully desk-based or exclusively remote. Care Managers will balance telephonic care management responsibilities with regular field-based member visits and travel throughout the assigned Kansas service area. Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Requirements
- Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing
- 2 – 4 years of related experience.
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
- Candidates must reside in Kansas, with a strong preference for individuals who live in or near the northwest Kansas service area.
- Must be comfortable driving throughout the region and completing in-home visits based on member needs and availability.
Nice To Haves
- For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL
- For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel required
- For Trillium Community Health Plan Only: RN (Registered Nurse) licensure in Oregon required
Responsibilities
- Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
- Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
- Identifies problems/barriers to care and provide appropriate care management interventions
- Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
- Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
- Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
- Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
- May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
- Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
- Other duties or responsibilities as assigned by people leader to meet business needs
- Performs other duties as assigned.
- Complies with all policies and standards.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
