Nurse Case Manager

Company: Neighborhood Health Plan of RI
Location: East Providence
Posted on: November 14, 2020

Job Description:

The Medical Case Manager (RN) works collaboratively with the health care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.

This role is on the   MMP Team-Assessments.

Practice case management within the scope of licensure.

Utilizes case management principles and sound clinical judgment in coordinating care for a specific member population

Performs intensive case management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to: Performing a comprehensive assessment

Care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, Behavioral Health Professionals and other involved health care professionals and community agencies, as appropriate

Communicate with providers to facilitate needed care

Implements care plan, facilitates referrals, coordinates services and resources and provides ongoing monitoring and re-evaluation of outcomes

Continuous monitoring and evaluation of the care outcomes and identification of service gaps

Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings

Off-site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required

Provides comprehensive documentation of all activities and contacts in Case Management software system

Facilitates referrals and coordinates needed services

Collaborates with team as necessary in identifying needed services and supports

Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers

Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner

Provides clinical oversight to community outreach and other team members; providing direct supervision of community outreach staff as appropriate regarding individual case status

Serves as a clinical resource to respond to questions from various departments

Provides cross-coverage as assigned

Participates in outreach/marketing activities as needed and as appropriate

Other duties as assigned

Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications Required:

Registered Nurse with an active, current, unrestricted license in RI in good standing (Consideration will be given to individuals without current RI license. Must provide documentation confirming RI RN application prior to offer)

Minimum of 3 years care management or community health nursing experience

Demonstrated experience in Medicare/Medicaid (MMP), Medicaid, Medicare or commercial products

PC based software programs – intermediate level of proficiency

Strong organizational and interpersonal skills

Customer service orientation

Ability to work independently and prioritize activities

Must have access to reliable transportation

Qualifications Preferred:

Managed Care experience

Two to Four (2-4) years’ experience in acute care

RN with Bachelor’s Degree or Certification as a CM

Clinical specialty experience

Bilingual

Core Company-Wide Competencies:

Communicate Effectively

Respect Others & Value Diversity

Analyze Issues & Solve Problems

Drive for Customer Success

Manage Performance, Productivity & Results

Develop Flexibility & Achieve Change

Job Specific Competencies:

Collaborate & Foster Teamwork

Create & Innovate

Plan & Organize

Exercise Sound Judgement & Decision Making

Flexible Work Arrangement:

Yes

Telecommuting Arrangement:

Yes, ad-hoc

Travel Expectations:

Travel 50-74% of the day. Must have access to reliable transportation.

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org .

Neighborhood is an EOE M/F/D/V and an E-Verify Employer

Keywords: Neighborhood Health Plan of RI, East Providence , Nurse Case Manager, Other , East Providence, Rhode Island