Nurse Case Manager Senior - Field Nurse

Nurse Case Manager Senior - Field Nurse

Work location: This field-based role located in the Hall County, GA area enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This position will include but not limited to the following GA counties: Hall, Gwinnett, Habersham, Banks, Jackson and Forsyth. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Work schedule: Monday - Friday 8:00am to 5:00pm EST with 1 late evening shift 11:00am to 7:30pm EST.

This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria.

The Nurse Case Manager Senior - Field Nurse is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties primarily in the field with some being done telephonically. This position does involve traveling to attend health plan-sponsored events, individual and group presentations. This position does not involve in-home visits.

How you will make an impact:

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Assists in problem solving with providers, claims or service issues.
• Coordinate referrals to local and statewide resources including behavioral health, housing, transportation, and food assistance.
• Partner with community health organizations, advocacy groups, and outreach teams to strengthen member connections.
• Plan, coordinate, and deliver educational events in collaboration with community partners, employers, or local health organizations.
• Provide group-based and one-on-one education on chronic conditions, medication adherence, preventive screenings, nutrition, and self-care.
• Support initiatives that address health equity and promote culturally responsive care.
• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
• Participates in department audit activities.

Minimum requirements:

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.

Preferred Capabilities, Skills and Experiences:

• Nursing experience in Home Health, Managed Care, Case Management, or Care Coordination.
• Case Management Certification.
• Strong communication and presentation skills.