RN Care Manager

🕒 Ontem

🔔 Pennsylvania – Remoto

🔔 Pennsylvania – Remote

💵 $29 - $54 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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• Aberta há 2 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 meeting established criteria • Educate members and promote self-management, quality care, and cost-effective outcomes • Assess member needs, review service and resource options, and develop and implement individualized care plans • Coordinate resources, monitor progress, evaluate member status, and discharge members when criteria are met • Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs • Provide counseling and referrals to community, local, state, and other 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 liaison among participants, families, physicians, and treatment team members • Develop prioritized goals and health actions supporting self-directed care and improved health outcomes • Advocate for members and families by coordinating care and navigating resources • Analyze referrals and conduct assessments to determine enrollment, acuity, functional status, psychosocial status, and barriers • Obtain required consent forms • Conduct and document care management activities according to policies and procedures • Build relationships and implement interventions supporting member stabilization, knowledge, self-management, and long-term care outcomes • Identify and report quality-of-care issues • Maintain member confidentiality • Attend required company and departmental meetings and training sessions

🎯 Requisitos

• At least three (3) years’ recent/related experience • Registered Nurse with active licensure in home state • Additional state’s licensure as needed/required to meet customer needs • Certified Case Management certification within 2 years of employment • 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 • Strong communication, clinical process, critical thinking, and problem-solving skills • Excellent written, oral communication, listening, and organizational skills • Ability to use a computer system while conversing telephonically • Microsoft Office proficiency • Knowledge of NCQA, DMAA, CMSA, Act 68, CMS, and ERISA standards • 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 • Ability to prioritize workload and complete duties accurately and timely • Ability to work autonomously and as part of an interdisciplinary team • Ability to travel to provider, facility, employer group, and/or member locations using own vehicle, if appropriate

🏖️ Benefícios

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible work environment • Training and continuing education • Opportunities to volunteer in the community

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