RN Care Manager

🕒 Outubro 2

🔔 Pennsylvania – Remoto

🔔 Pennsylvania – Remote

💵 $29 - $54 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

👻 Score fantasma 11%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 41 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.

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Capital Blue Cross

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1938

🏥 Saúde

💼 Consultoria

🛡️ Seguros

Healthcare • Consulting • Insurance

A Capital Blue Cross é uma companhia de seguros de saúde que oferece uma gama de planos de saúde para indivíduos, famílias e empregadores. Eles atendem clientes na região central da Pensilvânia e no Vale de Lehigh, com foco em fornecer serviços de cobertura de saúde, como planos Medicare, planos de saúde estudantil e recursos para gerenciar cuidados médicos. A Capital Blue Cross se posiciona como uma parceira na saúde, enfatizando o apoio ao bem-estar geral dos membros e medidas de saúde preventiva.

Descrição

• Coordinate services for members who meet established criteria • Educate members and promote self-management, quality care, and cost-effective outcomes • Assess member needs and review service and resource options • Develop and implement individualized plans of care • Coordinate resources and monitor member progress • Evaluate member status and discharge members when criteria are met • Document the individualized member care management process and outcomes • Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs • Provide counseling and referrals to community, local, and state programs • Collaborate with caregivers, providers, community agencies, behavioral health teams, and other resources • Manage and oversee a caseload of moderate- to high-risk members with complex needs • Serve as a liaison among participants, families, physicians, and treatment-team members • Analyze and evaluate referrals for potential program enrollment • Conduct assessments to determine acuity, functional status, psychosocial status, and barriers • Obtain required consent forms • Apply discharge criteria and discharge members from care management programs • Identify and report quality-of-care issues • Maintain member confidentiality • Attend company and departmental meetings and training sessions

🎯 Requisitos

• Registered Nurse with active licensure in home state • Additional state licensure as needed/required to meet customer needs • Certified Case Management certification within 2 years of employment • At least three (3) years’ recent/related experience • Knowledge of NCQA standards for Population Health Management • Knowledge of DMAA standards for disease management • Knowledge of CMSA Standards of Practice for Case Management • Knowledge of Act 68, CMS, and ERISA • Knowledge of evidence-based guidelines for chronic conditions/care management • Knowledge of clinical and managed care principles and operations • Knowledge of current and emerging medical treatment modalities and best practice guidelines • Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques • Proficiency in Microsoft Office Products • Strong clinical process, critical thinking, and problem-solving skills • Ability to work autonomously and as part of an interdisciplinary team • Compact RN license preferred • Care management, home health, medical/surgical behavioral health, and/or critical care experience preferred • Health plan experience preferred • Experience in health coaching and motivational interviewing techniques preferred

🏖️ Benefícios

• Medical coverage • Dental coverage • Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible work environment • Training and continuing education • Community volunteering opportunities

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