WFH Case Manager RN II

Job Summary

The Case Manager 2 manages complex cases and is responsible for supporting the Case Management team and Health Services leadership in ensuring complex cases meet regulatory and accreditation requirements. May manage a high acuity caseload and serve as a preceptor for newly hired case managers.

Essential Functions Of The Role

Performs general and complex case management activity to include collaboration with member, family, significant others, providers, and community agencies to conduct a comprehensive member needs assessment and develop a customized plan of care with mutually established long term and short term goals. Advocates for the member to coordinate quality and cost effective services to meet the member care needs and established goals. Identifies and reports potential quality of care issues and uses collaborative strategies and open communication to resolve issues and barriers in the member's best interest. Achieves established production and quality metrics as defined by management.

Demonstrates initiative and voluntarily provides assistance and team support to facilitate the achievement of individual, department and plan goals. Assists, coaches, and mentors team members.

Maintains knowledge of all regulatory and accreditation standards. Completes documentation in accordance with all federal, state, NCQA and internal requirements without exception. Participates in quality auditing and monitoring activities under the direction of Health Services leadership. Participates in or leads departmental meetings as needed.

May maintain a smaller volume of high acuity / complex members in need of case management. Adheres to NCQA standards for documentation of assessments, care plans and ongoing case management needs.

May serve as a preceptor for newly hired case managers including review of case documentation, case findings reports and other data. Assists on special projects to improve efficiencies and case management outcomes.

KEY SUCCESS FACTORS

For RN : Associate's degree or Graduate of an Accredited Program in nursing required; Bachelor's degree in nursing preferred.

Five years of relevant experience in health care setting, behavioral health, or managed care setting required.

Case Management Experience Required.

Certified Case Manager (CCM) certification from the Commission for Case Management certification preferred.

Experience leading and directing others in a similar setting preferred.

Solid knowledge of available tools and resources essential to the application of case management principles and performance of case management activities.

Able to maintain a comprehensive understanding of product lines, contracts, networks, systems and resources.

Able to effectively learn and use case management software, automated systems, or other applicable technologies. Skill in the use of computers and related software.

Excellent interpersonal, verbal and written communication, analytical, and organizational skills required.

Self-starter and able to work independently with minimal supervision or equally well within a team environment.

Demonstrates complex problem solving acumen.

Benefits

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note : Benefits may vary based upon position type and / or level

Qualifications

Registered Nurse (RN)