Nurse Case Manager II

Our client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Remote location.


Responsibilities:

• Help us elevate our patient care to a whole new level! Join our client team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models.
• You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.
• With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs.
• Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
• 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
• Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member's identified needs.
• Provides evidence-based disease management education and support to help the member achieve health goals.
• Ensure the appropriate members of the interdisciplinary care team are involved in the member's care.
• Provides care coordination to support a seamless health care experience for the member.
• Meticulous documentation of care management activity in the member's electronic health record.
• Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member's stable health condition.
• Identifies and connects members with health plan benefits and community resources.
• Meets regulatory requirements within specified timelines.
• The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
• Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members.
• This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.
• Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
• Conduct oneself with integrity, professionalism, and self-direction.
• Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
• Familiarity with community resources and services.
• Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintain strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.
• Excellent customer service and engagement skills.
• The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

• Verifiable High School Diploma or GED Required:
• Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY. Additional licensure is preferred but not required. NY is not a compact state, single state licensure for NY is required.
• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
• Access to a private, dedicated space to conduct work effectively to meet The requirements of the position.
• Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
• Minimum 3+ years of nursing experience
• Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience
• Experience providing care management for Medicare and/or Medicaid members.
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
• Experience conducting health-related assessments and facilitating the care planning process.
• Bilingual skills, especially English Spanish, preferred not required
• Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
• Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY.
• Additional licensure is preferred but not required.
• NY is not a compact state, single state licensure for NY is required.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities