RN Case Manager

Career Center•Mount Sterling, KY

About The Position

The RN Case Manager manages and supports daily case management strategies for coordinating care for a group of 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 calls for a self-starter and team player who can manage multiple priorities, work with minimal supervision on assigned projects and activities, communicate and present effectively, adapt quickly to change, and collaborate across teams. The RN Case Manager also completes health risk assessments, manages assigned caseloads, coordinates discharge planning and member education, supports audits and improvement projects, and responds to day-to-day care coordination issues. The role requires an RN graduate of an accredited program and an active nursing license in the assigned state. A bachelor’s degree, current CCM license, and CPR for Healthcare Professionals certification are preferred or specified as preferred where noted. A valid driver’s license and current motor vehicle insurance are also required.

Requirements

At least 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
2 years of managed care experience required.
Graduate of an accredited RN program.
Current license to practice as a registered nurse in the assigned state.
Current valid driver’s license.
Current motor vehicle insurance.
Ability to manage multiple priorities and work with minimal supervision on assigned projects and activities.
Excellent communication and presentation skills; ability to adapt quickly to change and collaborate with multiple teams.

Nice To Haves

3–5 years of case management experience in a managed care environment, preferably with a managed care organization or similar facility.
Bachelor’s degree.
Current CCM license.
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 Home/Facility staff as needed, based on identified learning needs and using available teaching resources.
Coordinate outpatient discharge planning based on patient needs, clinical circumstances, and benefit coverage.
Participate in Managed Care-related 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 increase or maintain 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/Home.
Visit patients in person and/or by telephone to ensure proper nursing care.
Interview or correspond with physicians to correct errors or omissions and investigate questionable claims.
Perform other duties as assigned.