CCM Case Management RN

Oscar Health•Florida, United States, FL

15d•$33 - $43•Remote

About The Position

This is a telephonic case management role in which you will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with the Clinical Concierge Specialist and other Oscar teams to ensure exceptional care for our members. The work location is remote and open to candidates residing in Arizona, Florida, Georgia, and Texas. While daily work is completed from a home office, occasional travel may be required for team meetings and company events. Internal applicants living outside of the listed locations will be considered if they meet all job requirements and internal transfer eligibility criteria. The base pay for this role is $32.60 - $42.79 per hour. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year.

Requirements

2+ years of clinical experience.
Active, unrestricted Nursing license (RN) in your state of hire and ability to obtain additional licensure as needed.

Nice To Haves

Working knowledge of Milliman Care Guidelines
Case Management experience
CCM certification
BSN
Previous work from home and proven comfort with accessing systems remotely
Bilingual in Spanish or Creole

Responsibilities

Assist in the coordination of care across a variety of settings (ER, inpatient, post acute, outpatient, home care) while maintaining strict confidentiality and the highest level of professionalism.
Actively reach out to members undergoing difficult health challenges and help guide them through the healthcare system to improve their overall experience.
Complete a comprehensive biopsychosocial needs assessment to help identify member needs.
Develop an outcome-based plan of care, based on the member’s input and assessed clinical and social needs with anticipated targeted dates for accomplishment.
Conduct in-home and facility visits to engage and educate the member (and their family/caregivers).
Attend doctor appointments with members and collaborate with their providers to assist them in better understanding their plan of care.
Proactively reach out to hospital case managers to assist with safe discharge planning to appropriate level of care or home.
Seek guidance from medical directors to advocate for members to get the appropriate care they need. Act as a member advocate and assist with problem solving, as well as addressing any barriers to care or compliance with the care plan.
Educate other teams on the CCM program and collaborate to identify high risk members who would be appropriate.
Work with non-clinical teammates in assisting members to navigate the healthcare system, including coaching non-clinicians on how they can add value to all member interactions.
Communicate with members via phone, secure messaging, and in person to provide education on health conditions, new medications, and procedures.
Participate in surveys, studies, and special projects as assigned.