RN Care Manager - Condition/Disease Management Focus

Network Health WI•Menasha, WI

6d•Remote

About The Position

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes.

Requirements

Graduation from accredited school of nursing
RN licensure in the State of Wisconsin
Four years of clinical health care experience as a RN required

Nice To Haves

Bachelor’s degree in Nursing preferred
Case Management certification preferred
Chronic condition management experience preferred, especially: Diabetes, Cardiac, Pulmonology
Previous experience in case management, utilization management, insurance, or managed care preferred
Experience with Medicare, Medicaid preferred

Responsibilities

Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines.
Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies.
Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved.
Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff.
Evaluate and process member referrals from physicians to other specialty providers.
Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met.
Works with members and families on self-management approaches using coaching techniques such as motivational interviewing.
Educate the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes.
Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality.
Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
Stay abreast of current best practices and new developments.
Other duties as assigned