Complex Case Manager RN - Pediatrics (Remote)

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Requirements:

• 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
• RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.
• Certification in Case Management (Preferred)

Responsibilities:

• Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
• For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
• Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
• Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
• Other duties as assigned or requested.