Care Manager (RN)

Position Summary:

The role of the Care Manager is to advocate on behalf of the member to ascertain quality, cost-effective services at the appropriate level of care and to ensure that the member has access to needed services at all times. This role of advocacy will assist the member in maximizing his/her potential and optimizing wellness.

Background & Context:

The Organization services members with multiple high-cost medical, behavioral, and psycho-social needs. The goal of the Care Management Program is to assist members in achieving the highest possible level of wellness, functioning and quality of life. Members enrolled in the Care Management program receive condition specific education, ongoing assessments of needs, identification of both short- and long-term goals, timely communication and collaboration between member and provider as well as the servicing providers when service coordination is needed. Team of Nurse Care Managers with one Care Coordinator for non-clinical support. Main goal is enrollment into our CM program for the high needs/high cost Medicaid members that are identified by various sources such as reports, discharge census, self-referrals, and providers.

Key Responsibilities:

* Telephonic outreach both inbound and outbound to/from members.

* May need to call providers for coordination of care.

* Must be able to use a computer for all documentation working in multiple systems & programs.

* Outbound calls to providers as needed to coordinate care for members.

* Provide health education and resources to members.

* Locate and provide community resources.

* Timely documentation of interactions with members within 24hrs and sending appropriate letters and resources.

* Timely follow up with members at a minimum every 30 days at least 90% or greater of the time.

* Referrals appropriately to other team members (example- Social Work, Behavioral Health, Disease Management, Pharmacy, etc).

* Motivational interviewing and Engagement techniques for cold calls to members about enrollment in CM program.

* Telephonic Case Management with 100% computer-based documentation.

* Discharge Planning with documentation computer based.

* Medical Surgical Nursing with documentation computer based.

* Home Health Nursing with documentation computer based.

* Field/Face-to-face visits.

Qualification & Experience:

* Required: Previous Telephonic CM. * Medical Surgical Nursing, minimum of 2-3 years. * Home Health (any amount of time). * Comfortable working with all age groups from birth to adult. * Required: Registered Nurse (Bachelors or Associates RN). Must be RN in GA or compact. * Preferred: CCM. * Preferred: Bachelors.

* Years of experience required: 2-3 years telephonic CM, Medical Surgical Nursing/home health IN PERSON- minimum of 2-3 years. * Disqualifiers: Must live/reside in Georgia for this role, most recent position must be within the industry, will look at length of experience and gaps (please state if contractor role, please state why the gaps).

* Additional qualities to look for: NICU background. * Top 3 must-have hard skills: 1. Computer efficiency using Outlook and Microsoft office (primarily Word and basic Excel, Teams chat). 2. Telephonic experience with members for motivational interviewing and to gather assessment data. 3. Med/Surg & Home Health (ages birth to adult).