HSCSN RN Care Manager

Health Services for Children with Special Needs•Washington, WA

14h•Hybrid

About The Position

The RN Care Manager manages a caseload as outlined by CASSIP and Care Management Leadership, maintaining compliance with contractual and care management requirements. This role assists in research and implementation of disease management/population health programs for high-complexity members. The Care Manager conducts outreach and face-to-face visits in homes, physician's offices, or other agreed-upon locations, assessing enrollees to identify needs and gaps in care. They identify and address over/under utilization, develop and implement individualized care plans in collaboration with multidisciplinary teams, and complete routine care coordination activities in compliance with company policy and NCQA standards. The role involves consulting with Supervisory Care Managers, accurately documenting enrollee findings, and adhering to confidentiality policies. The RN Care Manager participates in disposition and discharge planning, educates caregivers/enrollees on self-management, and assists with scheduling and monitoring appointments. They apply advanced knowledge of conditions and care management approaches, attend multidisciplinary meetings, review vendor reports, and facilitate coordination of follow-up care. The role also involves referring enrollees to appropriate vendors for DME/assistive technology and education, assisting with transitions of care, and entering authorizations for services. Ongoing monitoring of care plans, communication with stakeholders, and positive presentation of HSCSN are key functions. This is a Hybrid role, with time spent in the field engaging enrollees in the community.

Requirements

Associate's Degree in Nursing (Required)
2 years Clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or Managed Care (Required)
1 year Working in a Public/community health setting. (Required)
Must have an advanced knowledge of clinical standards of care and disease processes.
Must have excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for enrollees.
Must be able to provide excellent internal and external customer service.
Proficient in the knowledge of available community resources and programs.
Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.
Must have the ability to produce accurate and comprehensive work products with minimal direction.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external stakeholders within set expectations for service excellence.
Must have a basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
Facilitates care team meetings, participates in professional, multidisciplinary meetings to include internal and external staff meetings.
Registered Nurse DC License Upon Hire (Required)

Nice To Haves

Bachelor's Degree in Nursing (Preferred)
Spanish Speaking preferred
Certified Case Manager (CCM) 1 Year (Preferred)

Responsibilities

Manages a caseload as outlined by CASSIP and Care Management Leadership.
Maintains compliance in accordance with contractual and care management requirements.
Assists in research, and implementation of disease management/population health programs to serve our highest complexity members.
Conducts outreach and face-to-face visits at a frequency no less than determined by the enrollee’s assigned acuity level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations.
Assesses enrollees on enrollment and at intervals no less than determined by the enrollee’s acuity level to identify needs/barriers and close gaps in care.
Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.
Develops, implements, and updates an accurate, individualized comprehensive care plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members, including public agencies.
Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and NCQA standards.
Consults with Supervisory Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns.
Accurately and timely documents enrollee findings and interactions according to organizational policy.
Understands and abides by HSCSN’s Confidentiality policy and procedure regarding enrollee specific information.
Participates in disposition and discharge planning activities.
Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources.
Clearly and respectfully communicates verbally and in writing.
Assists/empowers caregivers or enrollees to participate in care of child /self.
Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services.
Strives to achieve target rate of compliance for preventive medical and dental services.
Assists with scheduling and monitors the compliance of mental health/medical appointments.
Follows department policies for identifying and reporting noncompliance, missed appointments, and other reportable incidents including communication to primary care provider or specialist.
Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.
Attends multidisciplinary meetings as necessary, including off-site meetings with other involved agencies.
Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.
Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use.
Educates on medication administration, their conditions, and techniques for self-management within the scope of license.
Refer, as needed, to the appropriate vendor for additional education.
Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of HSCSN when the enrollee ages out or is disenrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care.
Enters authorizations for services requiring authorization by Care Management staff.
Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and updates accordingly.
Uses communication skills which promote understanding and collaboration with enrollees and their families, HSCSN staff, providers and others.
Positively presents accurate information about HSCSN to enrollees and their families, HSCSN staff, providers, coworkers and the community.
May perform other duties in addition to those outlined in this job description.