Care Manager (RN)

Job Title

Contract Type: Contract to Hire

Work Mode: Field Worker

Responsibilities:

• Evaluate the needs of the member, barriers to accessing appropriate care, and social determinants of health needs, focusing on what the member identifies as a priority.
• Develop ongoing care plans/service plans and collaborate with providers to identify resources to address member's unmet needs.
• Identify problems/barriers to care and provide appropriate care management interventions.
• Coordinate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
• Provide ongoing follow-up and monitoring of member status, changes in condition, and progress towards care plan/service plan goals.
• Provide resource support to members and care managers for local resources for various services based on service assessment and plans, as appropriate.
• Facilitate care management and collaborate with appropriate providers or specialists to ensure timely access to needed care or services.
• Perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
• Collect, document, and maintain all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations.
• Provide and/or facilitate education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
• Provide feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements:

• Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing.
• Minimum 2 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• For YouthCare Illinois plan only: Bachelor's Degree and IL RN licensure required. Must reside in IL.
• For Sunshine Health (FL) Only: Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel.