RN Case Manager

Responsibilities Executes on strategies and goals set by the Align Senior Care Board of Directors, the Senior Leadership Team, and Executive Director for managing and improving overall Member experience. Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting. Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options. Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members. Routinely follows up with member as scheduled to assess progress towards goals. Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals. Provides patient-centered intervention, such as making and verifying appointments, performing medication and care compliance initiatives. Acts as front-line support with Members and their RP/POAs to ensure the needs of the Member are met. Serves as a connection point among Members, their Communities, their Care Team, and Align Senior Care internal departments. Regularly engages Align Senior Care Members and RP/POAs in-person or by phone to provide education and assistance with utilizing Align Senior Care benefits. Including but not limited to checking on upcoming specialist appointments, connecting members to supplemental benefits and providers, identifying immediate Member needs, and answering any questions the Member or RP/POA may have. Communicates Member health updates from Care Team to RP/POAs. Coordinates with the Care Team for non-urgent health or clinical questions. Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues. Updates Member and RP/POA contact information such as changes of address, email, or phone numbers. Actively supports Account Manager in identifying and securing contracts with "preferred" Providers. Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments. Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members. Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team. Ensures documentation of care team meetings and transmits to Plan. Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members. Monitors midnight reports/community census to help identify member transitions to hospital or other care levels. Requirements One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care. Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding. Case management certification preferred. Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred OR Active Licensed Social Worker (LSW). Bachelor's degree in social work (BSW) required. #J-18808-Ljbffr Jobtailor