Case Manager RN (52895)

GLOBALHEALTH HOLDINGS LLC • Oklahoma City, OK

39d • Remote

About The Position

Under the direction of the Supervisor, Care Management, the Case Manager RN performs and manages care management activities to improve members’ long-term wellness and advocates for members through coordination of care. The role conducts telephonic case management for complex, high-risk members, coordinating with providers, care teams, and community resources as applicable. It also supports member and caregiver education, the Special Needs Plan Model of Care, and transitions of care.

The position is currently remote, subject to some state exclusions. The employee must have access to a reliable, secured internet connection and maintain a work environment that protects confidential business information and Protected Health Information (PHI) in accordance with HIPAA and company policies. The role has no travel or supervisory responsibilities.

Requirements

• Active Registered Nurse license in the state of Oklahoma.
• Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources.
• Strong attention to detail and good organization and time-management skills, including the ability to multitask, learn new skills, and reach set goals.
• Ability to communicate clearly and effectively, both orally and in writing.
• Knowledge of Microsoft Word, Excel, and PowerPoint.
• Proven ability to work independently or as a member of a team.
• Access to a reliable and secured internet connection.
• Ability to maintain confidentiality and protect PHI in accordance with HIPAA and company policy.

Nice To Haves

• Active multistate RN license.
• Previous experience in managed care or utilization management.

Responsibilities

• Conduct telephonic case management for complex, high-risk members, including identifying and assessing needs, planning and coordinating care, and monitoring outcomes in accordance with company and departmental policies and procedures.
• Coordinate with providers, when applicable, to support holistic and beneficial outcomes.
• Communicate respectfully with members and others while considering family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, and mental or physical challenges.
• Use interdepartmental communication, network communication, and member outreach to remain aware of patient needs and changes in condition; provide advocacy, support, quality-of-care assessment, and crisis intervention.
• Coordinate member services, including community resources, and collaborate with other care-team members.
• Educate members and caregivers about conditions and self-management techniques.
• Initiate and participate in all elements of the SNP Model of Care, including completing the HRA, creating the ICP, and initiating the ICT.
• Complete transitions-of-care activities, including post-discharge assessment, medication reconciliation or review, and ensuring members have access to follow-up care.
• Protect confidential business information and PHI using reasonable and necessary safeguards and follow company privacy and security policies.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED