Care Manager RN CW
Care Manager RN CW
Posted on :
30-11-2024
Employer Active
1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
30-11-2024
Job Description
Overview:
TekWissen is a global workforce management provider headquartered in Ann Arbor Michigan that offers strategic talent solutions to our clients worldwide. Our client is a health and wellness organization located in Pittsburgh and operates health insurance plans in Pennsylvania Delaware and West Virginia.
Job Title: Care Manager RN CW
Location: New Castle DE
Duration: 3 Months
Job Type: Contract
Work Type: Hybrid
Job Description:
- This job works directly with providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted in relation to quality and care costs.
- The incumbent could work in a physicians office visit physician practices on a routine basis work within a hospital setting and/or visit the members home.
- This job directly helps members with the highest risk scores to coordinate care and navigate the healthcare system by recommending and/or implementing interventions related to the improvement of medical care and costs.
Responsibilities:
- Travel to members homes nursing facilities and other community based settings in order to complete face to face needs assessments with subsequent telephonic contact with the member in accordance with state and national guidelines policies procedures and protocols.
- Assess plan coordinate implement and evaluate care for eligible members with chronic and complex health care social service and custodial needs in a nursing facility or home and communitybased care setting.
- Coordinate care across the continuum of services and assisting members physical behavioral long term services and supports (LTSS) social and psychosocial needs in the safest least restrictive way possible while considering the most costeffective way to address those needs.
- Facilitate authorization coordination continuity and appropriateness of care and services in community or HCBS.
- Facilitate transitions to alternate care settings such as hospital to home nursing facility to community setting using an integrated care team to address the members specific needs.
- Educate members or caregivers regarding health care needs available benefits resources and services including available options for long term care community or facilitybased service delivery.
- Provide education resources and assistance to help members achieve goals as outlined in their plan of care and to overcome obstacles to achieving optimal care in the least restrictive environment.
- Develop a plan of care in conjunction with members or caregivers to identify services to meet the members specific needs and goals.
- Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management Behavioral Health and Complex Case Management.
- Collaborate with the members health care and service delivery team including the DSHP Plus LTSS Member Advocate ICT and discharge planners to coordinate the care needs and community resources for the member in order to maintain the member in the least restrictive safe environment possible. Assist members in developing implementing and amending a backup plan for gaps in provider coverage.
- Ensure approved support services are being provided as outlined in the plan of care. Evaluate the effectiveness of the service plan and making appropriate revisions as needed in accordance with per policy & procedures and state contractual requirements.
- Assist members in overcoming obstacles to optimal care through connection with community resources including communicating with providers and formulating an appropriate action plan.
- Document all case management services and intervention in the electronic health record. Adhere to all company State and Federal requirements related to privacy practices HIPAA and quality performance standards.
- Perform other duties as assigned/requested.
Qualifications:
- Registered Nurse and 2 years of experience in longterm care home health hospice public health or assisted living
- One year in home clinical or case management experience
- Medicare and Medicaid experience
- Managed care experience
- Working flexible hours to meet members needs
- Proficiency in PCbased word processing and database documentation (Word Excel Internet Outlook)
- Reliable transportation daily to be able to travel within assigned territory
- Ability to meet regulatory deadlines.
- Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies.
- Experience in geriatric special needs behavioral health home health
- Understanding of the importance of cultural competency in addressing targeted populations.
- Experience with electronic documentation system(s)
- Experience with cost neutrality and budgeting
- Must be willing to travel throughout the state (may only need to travel 23 times a week depending on schedule)
- Must have reliable transportation
- Must be able to communicate clearly to members will be tasked with conducting assessments with members over the phone
- Must have good computer skills
- Must be very organized
TekWissen Group is an equal opportunity employer supporting workforce diversity.
Employment Type
Full Time
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