Senior RN Case Manager - Complex Care & Advocacy

Job Description Job Description The RN Case Manager II provides comprehensive integrated case management for SCO members with complex needs and/or catastrophic illness or injury, to ensure cost effective and efficient utilization of health services, while in a healthcare institution such as a hospital, rehab facility or skilled nursing facility. This professional serves as a patient advocate seeking and coordinating creative solutions to patients’ health care needs without compromising quality of outcomes. This individual provides leadership and professional expertise to other Case Managers and provides expert guidance and leadership with regard to the continuum of care. This position is full time M-F 8am to 4pm with no weekend or holiday hours. ESSENTIAL RESPONSIBILITIES: Collaborates with the members’ treating physician(s), ancillary providers, and family/care givers, utilizing a multi-disciplinary approach to problem identification, communication and negotiation to develop prioritized long/short-range goals. Matches patients’ care needs to available resources; ensures that the members stay at appropriate levels and make adjustments when necessary. Responsible for: Assessing clinical information to develop treatment plans and appropriate outcomes; Identifying cases with potential for high risk complications; Serving as an advocate for the members health care needs; Evaluating the quality of necessary medical services; Identifying cases that would benefit from alternative care; and Recommending opportunities to maximize cost effectiveness. Coordinates the delivery of quality patient care by demonstrating expertise and effectiveness of complex case management for members of varying complexities through advanced problem solving techniques. Maintains communication with Commonwealth Care Alliance (CCA), the other Case Managers, the Geriatric Social Service Coordinators (GSSC) and providers in community, as appropriate. Manages special projects/additional tasks while maintaining the plan’s inpatient caseload. Serves as the Lead Subject Matter Expert on the ESPNS SCO Team. Performs other duties, as assigned. JOB SPECIFICATIONS: Registered Nurse currently licensed in the Commonwealth of MA. Bachelor’s Degree (preferred) in related Health/Nursing field. Minimum of 5 years relevant experience in health care and/or case management field. Experience working on the community level and with community agencies preferred. Eligible for Case Management Certification. Proficient in the use of MS Office tools. Experience working with case management data systems. Able to travel locally on a frequent basis. Covid vaccine required. EEO Statement Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability. Element Care is committed to valuing diversity and contributing to an inclusive working environment. PI90694a707721-25405-35441513 #J-18808-Ljbffr