Case Manager Jobs

About The Position

Requirements

• At least 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
• 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 for Healthcare Professionals certification.
• Current valid driver's license.
• Current motor vehicle insurance.
• Ability 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.
• 3–5 years of case management experience in a managed care environment, preferably with a managed care organization or similar facility.
• Current CCM license preferred.

Responsibilities

• Complete health risk assessments for members as assigned.
• Initiate, update, and revise care plans as needed.
• Maintain an assigned patient caseload.
• Evaluate, coordinate, and plan patient care in collaboration with an interdisciplinary health team; reassess and revise care plans 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 based on identified learning needs 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.
• Correctly apply medical management criteria.
• 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.
• Interview or correspond with physicians to correct errors or omissions and investigate questionable claims.
• Consult and coordinate with healthcare team members to assess, plan, implement, and evaluate patient care plans.
• Perform other duties as assigned.

Benefits

• Annual performance wage increases
• 401(k) retirement plan with company match
• Medical insurance
• Dental insurance
• Vision insurance
• Company-paid $50,000 basic life insurance
• Paid time off
• UKG Wallet access to pay faster
• Holiday pay
• Free telehealth through 98point6
• Continuing education opportunities
• Career advancement opportunities