Transplant Case Manager, RN

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

Responsibilities include but are not limited to :

• 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

Areas of Responsibility Scope of Practice :

Administration of medication and treatments

Case Management Concepts

Required Experience / Education :

Skills and Abilities :

License and Certifications :

What can Imagine360 offer you?

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.