Case Manager - Registered Nurse - Field

About This Role

This role involves facilitating the delivery of healthcare information and benefits, promoting wellness, and supporting health strategies for Community Care members. The Case Manager will assess, plan, coordinate, and advocate for health services, especially for catastrophically ill or chronically ill members, to optimize their wellness and medical outcomes.

Responsibilities

• Act as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
• Implement and coordinate all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care
• Interact with members/clients telephonically or in person, potentially meeting in their homes or worksites
• Assess and analyze injured, acute, or chronically ill members/clients medical and/or vocational status
• Develop a plan of care to facilitate appropriate condition management to optimize wellness and medical outcomes and aid timely return to work
• Communicate with member/client and other stakeholders (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person
• Prepare all required documentation of case work activities
• Interact and consult with internal multidisciplinary team to help member/client maximize best health outcomes
• Provide educational and prevention information for best medical outcomes
• Apply all laws and regulations that apply to the provision of rehabilitation services and individual insurance carrier instructions
• Conduct an evaluation of members/clients’ needs and benefit plan eligibility and facilitate integrative functions
• Utilize case management processes in compliance with regulatory and company policies and procedures
• Monitor member/client progress toward desired outcomes through assessment and evaluation

Requirements

• Active and unrestricted Connecticut (CT) Registered Nurse (RN) License
• 3+ years clinical practical experience (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members
• 2+ years case management, discharge planning, and/or home health care coordination experience

Qualifications

• Associate's Degree in Nursing or Nursing Diploma (Required), Bachelor of Science in Nursing (Preferred)
• 3+ years clinical practical experience (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members and 2+ years case management, discharge planning, and/or home health care coordination experience

Nice to Have

• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Proficiency with standard corporate software applications (MS Word, Excel, Outlook, PowerPoint)
• Efficient and effective computer skills including navigating multiple systems and keyboarding

Skills

* Required skills

Benefits

Certifications