RN Care Manager

🕒 il y a 25 jours

🔔 Pennsylvania – Distant

🔔 Pennsylvania – Remote

💵 $29 - $54 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

👻 Score fantôme 2%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Capital Blue Cross

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1938

🏥 Santé

💼 Conseil

🛡️ Assurance

Healthcare • Consulting • Insurance

Capital Blue Cross est une compagnie d'assurance santé qui propose une gamme de plans de santé pour les particuliers, les familles et les employeurs. Elle sert les clients du centre de la Pennsylvanie et de la vallée de Lehigh, en se concentrant sur la fourniture de services de couverture santé tels que les plans Medicare, les plans de santé pour étudiants et les ressources pour la gestion des soins médicaux. Capital Blue Cross se positionne comme un partenaire santé, mettant l'accent sur le soutien du bien-être global de ses membres et les mesures de prévention en santé.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• 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