Responsible for the coordination of services for members who meet established criteria, emphasizing education/self-management and promoting quality care and cost-effective outcomes.
Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome.
Address medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs.
Provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status.
Responsible for the management and oversight of a caseload of moderate - high risk Members with complex medical/behavioral /psychosocial needs.
Requirements
At least three (3) years’ recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred.
Health plan experience preferred.
Additional experience related to specialized positions (Oncology, Transplant, Maternity, Behavioral Health) will also be considered.
Transplant experience preferred.
Experience in health coaching and motivational interviewing techniques preferred.
Registered Nurse with active licensure in home state; additional state’s licensure as needed/required to meet customer needs.
Certified Case Management certification within 2 years of employment.
Compact RN license preferred.
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off, Holidays, and Volunteer time off
Incentive Plan
Tuition Reimbursement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
care managementhealth coachingmotivational interviewingcase managementbehavioral healthmedical/surgicaltransplanthome healthclinical assessmentdischarge planning