Job Description

Position Summary:

Under the general direction of the Manager, Care Management Programs, the Case Management Nurse is responsible for providing Case Management services to patients identified for or enrolled in these programs.

The Case Management Society of America (CMSA) states, Case managers are healthcare professionals who serve as patient advocates, supporting, guiding, and coordinating care for patients, families and caregivers as they navigate their health and wellness journeys. They serve as the center of communication, connecting individuals/caregivers with members of the healthcare team and community to impact acute and chronic disease management and improve population health.

Work Location:

This is a remote position, however due to payroll and tax considerations, we are only hiring candidates located in the following states: Iowa or Arizona. Applicants must reside or relocate to one of these states to be considered for the role.

Specific Position Requirements and responsibilities:

• Review program referrals for appropriateness of program enrollment, considering the patient, medical condition, and individual ICM customer parameters.
• Provide care coordination services to patients in the case management program, including educating, motivating, and empowering members to manage their medical condition(s).
• Telephonically manage medical conditions of our client populations, facilitating care between the patient and physician, education for self-management, and positive outcomes for the member.
• Work towards member wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. Perform the following activities on an ongoing basis relative to each enrolled patient:

a. Assessment

b. Coordination

c. Planning

d. Monitoring

e. Implementation

f. Evaluation

• Identify and coordinate appropriate providers, services, facilities, and community resources throughout the continuum of services. Ensure available resources are used in a timely and cost-effective manner.
• Conduct utilization review processes on assigned patients, extending authorization or length of stay as appropriate.
• Provide support and maintain cooperative working relationships with all Innovative Care Management departments.
• As part of the Care Management Nurse triage program, provide clinical advice and case management support to ICM departments.
• Maintain accurate records of all communications and interventions related to patient activities using appropriate ICM software.
• Provide timely verbal and written reports (to include interventions and estimated cost savings) to associated clients as directed.

Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:

• 5 years experience of direct patient care as an RN, required.
• Work experience at two or more points along the continuum of care (e.g. inpatient hospital, outpatient clinic, home health, etc.) preferred.
• Ability to effectively communicate, both in verbal and written form.
• Strong computer skills, required. This includes the ability to effectively use software to communicate with peers and patients in a remote setting, and the ability to quickly adapt to new software as-needed.
• Self-motivated with the ability to take initiative and work effectively in both an independent and
• collaborative business environment.
• Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness.
• Demonstrated ability to problem solve multifaceted and/or emotionally charged situations.
• Ability to engage in abstract thought.
• Ability to successfully manage conflict, negotiating "win-win" solutions.
• Strong organizational, task prioritization, and delegation skills.
• Strong focus on patient advocacy and empathy.

Education, Licensure, and Certification Requirements:

• Nursing Degree (RN) from Accredited School of Nursing, required.
• Bachelor's (or higher) degree in health-related field, preferred.
• Proof of successful completion of educational requirements for a Nurse (RN) as defined by the state in which the employee is to practice as well as proof of such licensure in good standing, required.
• Must obtain sufficient continuing education to maintain active licensure in each state where continuing education units (CEUs) are required.
• Ability to obtain other state licenses as required.

Work and Physical Conditions:

• Ability to maintain a secure, private workplace without interruption during the workday.
• Ability to use a computer keyboard and mouse 8-10 hours per day.
• Ability to dial, answer, and talk on a telephone with a headset for 8-10 hours per day.
• Ability to engage in sedentary activity by sitting or standing at a workstation for 8-10 hours.
• Ability to lift and transport office and computer equipment between office and home; less than 20 pounds.

Benefits:

• 17 PTO days
• 8 Holidays
• Medical: 100% company paid base plan for employees
• Dental & Vision
• FSA/HSA and Dependent Care
• 401K w/ match
• Short & Long Term Disability
• Accidental & Critical Illness
• Internet Stipend

PIe9fdea7ed179-30492-35316056

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