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Job Title: Care Manager (RN) Location: Remote (can sit anywhere in the US but must have a CA RN license and be able to work PST hours listed) Duration: 2 Months (Potential to extend) Shift: 8 - 5 pst Mon-Fri Job Responsibilities: Must have a private space/work area due to sensitive information. Must be comfortable to be on phones at home Training is about 3-4 weeks and then they will work with Senior Case Managers to start ramping up Experience Working with Medicare/Medi-caid Assisting with Backlog-referrals from CA-members sending referrals to case managers Will be Assigned 5-10 referrals daily. Ability to work in Fast paced environment Case Management exp required. At least 4 hours a day is spent on outbound phone calls-reaching out to members. Calls are recorded-will have audio audits. Data entry-tracking data Case load requirement is 75 active cases-(will be ramped up to this amt) Cases are 90 days. Excel (data entry-basic knowledge) True Care medical records system Must be able to navigate multiple systems. Pharmacy system, eligibility system, Workforce management Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs Provide patient and provider education Facilitate member access to community based services Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan Actively participate in integrated team care management rounds Identify related risk management quality concerns and report these scenarios to the appropriate resources Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems* Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan Actively participate in integrated team care management rounds Identify related risk management quality concerns and report these scenarios to the appropriate resources Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsals, treatment and provider options Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs Provide patient and provider education Facilitate member access to community based services Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan Actively participate in integrated team care management rounds Identify related risk management quality concerns and report these scenarios to the appropriate resources Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowled
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