Clinical - Care Manager II (RN)
Job Description Remote - Ohio - Lorain County 8-5 M-F
Job Description:
Position Purpose:
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Education/
Experience:
Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred.
2
years of clinical nursing experience in a clinical, acute care, or community setting and 1
years of case management experience in a managed care setting.
Knowledge of utilization management principles and healthcare managed care.
Experience with medical decision support tools (i.
e.
Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications:
Current state's RN license.
Texas Requirements:
Education/
Experience:
Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred.
2
years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.
2
years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
Experience with medical decision support tools (i.
e.
Interqual, NCCN) and government sponsored managed care programs.
Other state specific requirements may apply.
Licenses/Certifications:
Current state's RN license.
For New Hampshire Healthy Families:
Candidates with active RN license in good standing in other states than NH, must obtain the NH RN equi within 90 days of hire.
Active driver's license in good standing preferred.
CCM preferred.
For Arizona Complete Health - Complete Care plan:
Pediatrics assignments require 2
years' RN experience in pediatrics (clinical acute care, community or managed care setting) and 1
year experience in care management Obstetrics (OB) assignments require 2
years' RN experience in OB (clinical, acute, community or managed care setting) and 1
year experience in care management Licenses/Certifications:
Current state's RN license.
For Buckeye Community Health Plan:
Education/
Experience:
Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred.
2
years of clinical nursing experience in a clinical, acute care, or community setting and 1
years of case management or utilization experience in a managed care setting.
Knowledge of utilization management principles and healthcare managed care.
Experience with medical decision support tools (i.
e.
Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications:
Current state's RN license.
For Michigan Complete Health:
Licensed registered nurse; licensed nurse practitioner; licensed physician's assistant.
Valid driver's license required.
o Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options o Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes o Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients o Provide patient and provider education o Facilitate member access to community based services o Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan o Actively participate in integrated team care management rounds o Identify related risk management quality concerns and report these scenarios to the appropriate resources.
o Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience o Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems o Direct care to participating network providers o Perform duties independently, demonstrating advanced understanding of complex care management principles.
o Participate in case management committees and work on special projects related to case management as needed o For New Hampshire, Massachusetts,& Michigan Complete Health - home visits required Comments for Vendors:
Coverage for employee on leave of absence, approved by HR.
Lorain County caseload Long Term Care population Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):
Face to Face with members in Long Term Care and Assisted Living Facilities - assessments, Care Plans, review of medications, and any needs.
Describe the performance expectations/metrics for this individual and their team:
Member facing expectation, working closing with facilities and facility based members and their families.
Tell me about what their first day looks like:
Training with preceptor What previous job titles or background work will in this role? RN, Long term Care, Home Care, MDS ny future projected positions potentially coming up? Choose an item.
If yes, note:
Unsure Internal/External Groups with which the Candidate will interface:
Long Term Care and Assisted Living Members Required Skills/
Experience:
RN Licensure in GOOD standing Preferred Skills/
Experience:
Must reside in Lorain County 1.
Valid Drivers license, daily driving expectations 2.
RN, Long term Care , Home Care, MDS facility based long term care experience a must have 3.
Education Requirement:
RN licensure Education Preferred:
Software Skills Required:
Yes - electronic medical record experience, Excel, and Word Required Certifications:
Required Testing:
Recommended Skills Assessments Assisted Living Case Management Certified Case Manager Certified Nurse Practitioner Clinical Nursing Estimated Salary: $20 to $28 per hour based on qualifications.
Job Description:
Position Purpose:
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Education/
Experience:
Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred.
2
years of clinical nursing experience in a clinical, acute care, or community setting and 1
years of case management experience in a managed care setting.
Knowledge of utilization management principles and healthcare managed care.
Experience with medical decision support tools (i.
e.
Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications:
Current state's RN license.
Texas Requirements:
Education/
Experience:
Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred.
2
years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.
2
years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
Experience with medical decision support tools (i.
e.
Interqual, NCCN) and government sponsored managed care programs.
Other state specific requirements may apply.
Licenses/Certifications:
Current state's RN license.
For New Hampshire Healthy Families:
Candidates with active RN license in good standing in other states than NH, must obtain the NH RN equi within 90 days of hire.
Active driver's license in good standing preferred.
CCM preferred.
For Arizona Complete Health - Complete Care plan:
Pediatrics assignments require 2
years' RN experience in pediatrics (clinical acute care, community or managed care setting) and 1
year experience in care management Obstetrics (OB) assignments require 2
years' RN experience in OB (clinical, acute, community or managed care setting) and 1
year experience in care management Licenses/Certifications:
Current state's RN license.
For Buckeye Community Health Plan:
Education/
Experience:
Graduate from an Accredited School of Nursing.
Bachelor's degree in Nursing preferred.
2
years of clinical nursing experience in a clinical, acute care, or community setting and 1
years of case management or utilization experience in a managed care setting.
Knowledge of utilization management principles and healthcare managed care.
Experience with medical decision support tools (i.
e.
Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications:
Current state's RN license.
For Michigan Complete Health:
Licensed registered nurse; licensed nurse practitioner; licensed physician's assistant.
Valid driver's license required.
o Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options o Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes o Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients o Provide patient and provider education o Facilitate member access to community based services o Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan o Actively participate in integrated team care management rounds o Identify related risk management quality concerns and report these scenarios to the appropriate resources.
o Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience o Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems o Direct care to participating network providers o Perform duties independently, demonstrating advanced understanding of complex care management principles.
o Participate in case management committees and work on special projects related to case management as needed o For New Hampshire, Massachusetts,& Michigan Complete Health - home visits required Comments for Vendors:
Coverage for employee on leave of absence, approved by HR.
Lorain County caseload Long Term Care population Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):
Face to Face with members in Long Term Care and Assisted Living Facilities - assessments, Care Plans, review of medications, and any needs.
Describe the performance expectations/metrics for this individual and their team:
Member facing expectation, working closing with facilities and facility based members and their families.
Tell me about what their first day looks like:
Training with preceptor What previous job titles or background work will in this role? RN, Long term Care, Home Care, MDS ny future projected positions potentially coming up? Choose an item.
If yes, note:
Unsure Internal/External Groups with which the Candidate will interface:
Long Term Care and Assisted Living Members Required Skills/
Experience:
RN Licensure in GOOD standing Preferred Skills/
Experience:
Must reside in Lorain County 1.
Valid Drivers license, daily driving expectations 2.
RN, Long term Care , Home Care, MDS facility based long term care experience a must have 3.
Education Requirement:
RN licensure Education Preferred:
Software Skills Required:
Yes - electronic medical record experience, Excel, and Word Required Certifications:
Required Testing:
Recommended Skills Assessments Assisted Living Case Management Certified Case Manager Certified Nurse Practitioner Clinical Nursing Estimated Salary: $20 to $28 per hour based on qualifications.
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