RN Case Manager

Career Center•Ashland, KY

About The Position

The RN Case Manager manages and supports daily case management strategies for care coordination for members associated with a Medicare Advantage plan. The role includes visiting patients in person and/or by telephone to ensure appropriate nursing care, coordinating with physicians to correct errors or omissions and investigate questionable claims, and collaborating with healthcare team members to assess, plan, implement, and evaluate patient care plans. The position requires a self-starter and team player who can manage multiple priorities, work with minimal supervision, communicate and present effectively, adapt quickly to change, and collaborate with multiple teams. The case manager completes health risk assessments, maintains an assigned caseload, initiates and revises care plans, coordinates discharge planning, educates members and care staff, applies medical management criteria, and supports audits, reports, and improvement projects. The role also involves responding to care coordination issues and communicating with facilities and homes.

Requirements

Graduate of an accredited RN program.
Current license to practice as a registered nurse in the assigned state.
Minimum of 2 years of clinical nursing or rehabilitation experience with the geriatric population.
Two years of managed care experience required.
Current valid driver's license.
Current motor vehicle insurance.
Able to manage multiple priorities, work with minimal supervision on assigned projects and activities, adapt quickly to change, and collaborate with multiple teams.
Excellent communication and presentation skills.
Self-starter and team player.

Nice To Haves

Bachelor's degree preferred.
Three to five years of case management experience in a managed care environment, preferably with a managed care organization or similar facility.
Current CCM license preferred.
CPR for Healthcare Professionals certification.

Responsibilities

Complete health risk assessments for assigned members.
Initiate, update, and revise care plans as needed.
Maintain an assigned patient caseload.
Evaluate, coordinate, and plan patient care with an interdisciplinary health team; reassess and revise care plans in collaboration with other healthcare team members.
Provide patient and family education based on identified learning needs, using available teaching resources.
Provide education to members of home or facility staff as needed.
Coordinate outpatient discharge planning based on patient needs, clinical circumstances, and benefit coverage.
Participate in managed care audits and generate, maintain, and track periodic and annual reports and documents using MS Office and email to support the Care Coordination program.
Perform improvement projects, including developing monitoring and collection tools, reviewing medical records, entering and analyzing data, and preparing audit findings and reports.
Participate in patient care conferences, committee meetings, staff development, and educational programs to maintain or increase professional competency.
Apply medical management criteria correctly.
Research clinical questions from employers, members, and payers as required.
Educate members on health access options.
Respond to, manage, and resolve day-to-day care coordination problems and communicate effectively with the facility or home.
Visit patients in person and/or telephonically to ensure proper nursing care.
Coordinate with physicians to correct errors or omissions and investigate questionable claims.
Perform other duties as assigned.