Transplant Case Manager, RN

Imagine360

9d • Remote

About The Position

Imagine360 is seeking a Transplant Case Manager, RN to join the team! The Transplant Case Manager, RN is responsible to providing case management for individuals under the group health plans administered by Imagine360 by utilizing nursing education, clinical and professional experience. The Registered Nurse will practice within the scope of nursing practice while performing assessments, coordinating care, planning, monitoring, evaluating and determining outcomes.
Position Location: 100% remote

Requirements

• Graduate of Accredited School of Nursing, college or university required
• Minimum of one year experience in Utilization Management, Case Management, or transferable skills.
• Minimum of three years Transplant experience
• Intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software.
• Ability to work independently in a home office environment.
• Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet.
• Ability to resolve problems independently and demonstrate ability to multi-task.
• Strong written, oral, and telephonic communication skills.
• Strong presentation skills.
• Ability to demonstrate a commitment to building new skills and fostering a positive work environment.
• Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented.
• Demonstrated ability to prioritize workloads, multi-task, and manage priorities to meet deadlines.
• Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations.
• Must maintain active, current, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.
• Must be a Certified Case Manager or eligible to sit for the Certified Case Management Exam within 3 years of starting employment with i360.

Responsibilities

• Identify, collect, process, and manage data to perform the Case Management process by utilization Imagine360 approved clinical guidelines and following Medical Management Policy and Procedures
• Completes clinical assessments per P&P to identify and deliver indicated medical service coordination.
• Manage the transplant cases, cases that may lead toward organ transplant, and complex disease cases.
• Utilize clinical knowledge, expertise, and educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment.
• Assess the need for and collaborate with community resources for members in case management.
• Uses assigned software accurately to document to complete and document all steps of review of medical necessity and case management process, including time slips.
• Facilitate the Patient Satisfaction Surveys
• Assess for cost savings and document the cost saving in assigned software
• Appropriately refer complex cases to Supervisor, Case Management, or designee
• Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal and accreditation and regulatory standards.
• Performs assessments of each member to identify CM needs.
• Consistently exercises discretion and judgment to analyze, interpret, make deductions, and then decide what actions are necessary based on the varying facts and circumstances of each individual case.
• Determines measurable goals utilizing motivational interviewing and behavior change model and coaches' clients while monitoring self-care practices.
• Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate.
• Executes activities or interventions to achieve the goals in the plan.
• Organizes, integrates, and modifies the resources needed to reach the goals in the plan.
• Monitors all information from all relevant sources in the plan and its activities and services to determine the plan's effectiveness.
• At repeated intervals, evaluates to determine ultimate effectiveness of plan and modifies plan appropriately to meet the goals.
• Research medical procedures, treatments, and coding when necessary.
• Measures the outcomes of interventions.
• Adheres to practicing the care management core components throughout the continuum of care:
• Case Management Concepts
• Case Management Principles and Strategies
• Psychosocial and Support Systems
• Healthcare Management and Delivery
• Healthcare Reimbursement
• Vocational Concepts and Strategies.
• Customer Service
• Acts as a role model in demonstrating the core values in customer service delivery.
• Provides timely and thorough follow up with, internal and external customers.
• Appropriately escalates difficult issues up the chain of command.
• Quality Assurance
• Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
• Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
• Performs self-quality monitoring to develop and execute plans to meet established goals.
• Provides ongoing feedback to help optimize quality performance.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Develops new or improves current internal processes to improve quality.
• Attend and participate in team meetings, trainings, and other job specific events as required.
• Communicates (in compliance with HIPAA) with brokers, vendors, Relationship Managers, HR representatives and stop loss as needed.
• Communicates professionally and effectively.
• Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and department and company policies and Procedures.
• Participate in the Quality Management Program via collecting and adhering to performance metrics per Case Management Policy
• Complete HIPAA Training Annually.
• Perform all tasks in accordance with HIPAA/PHI guidelines.
• Appropriately escalate difficult issues.
• Complete duties in accordance with scope of licensure and certifications held or requested.
• Perform other duties and projects, as assigned.

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed