RN Case Manager

TruHealth•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, communicating with physicians to correct errors or omissions and investigate questionable claims, and coordinating 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 on assigned projects, adapt quickly to change, and collaborate with multiple teams. Strong communication and presentation skills are required.

Requirements

At least 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
At least 2 years of managed care experience.
Graduate of an accredited RN program.
Current license to practice as a registered nurse in the assigned state.
CPR certification for Healthcare Professionals.
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.

Responsibilities

Complete Health Risk Assessments for members as assigned.
Initiate, update, and/or revise care plans as needed.
Maintain an assigned patient caseload.
Evaluate, coordinate, and plan patient care with an interdisciplinary health team; reassess and revise plans of care 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 involving development of monitoring and collection tools, medical record review, data entry, analysis, and preparation of 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.