SWHR CIN Care Manager Registered Nurse (RN) - Full Time - Monday-Friday - 8:00am-5:00pm - Remote Position

Qualifications

• Associate's Degree in Nursing required.
• Bachelor's Degree in Nursing preferred.
• 3 years of Managed care and/or Clinical care experience required.
• Case Management experience required.
• Disease Management experience required.
• Utilization Management and Pre-authorization experience preferred. 
• RN - Registered Nurse required upon hire.
• CCM - Certified Case Manager or equal approved certification or must obtain within 18 months of employment or transfer into position 18 Months required.
• Strong analytical and organizational skills.
• Working knowledge and ability to apply professional standards of practice in work environment.
• Knowledge of specific regulatory, managed care requirements preferred.

Position Responsibilities SWHR Care Manager RN’s will support the Collaborative Care Management Model: Collaborating with physicians, social workers, pharmacists, and other professional staff in order to improve overall patient outcomes.

In addition to the required qualifications, a successful CST will:

• Responsible for meeting production goals on an ongoing basis as defined by leadership in order to meet business needs.
• Demonstrates effective caseload assignment through complex case management
  Demonstrates an understanding of funding resources, services, and clinical standards and outcomes.
• Demonstrates knowledge of case management standards of practice and processes including identification, assessment, planning, interventions, and evaluation.
• Demonstrates the ability to participate effectively in interdisciplinary team conferences specific to complex cases.
• Accountable for on-going compliance with the policies and procedures. This includes the standards of accrediting bodies and the regulations of state and local governing agencies (i.e. CMS and Nursing Practice Act)
• Demonstrate strong commitment to client service and delivers quality work product.
• Use interpersonal/communication skills and strategies with individuals to achieve: (a) desirable/acceptable outcomes/responses (b) perceptions of satisfaction or acceptance of those involved.
• Perform procedures required by the assignment: (a) safely, without causing harm (b) effectively, achieving the intended outcome/result (c) efficiently, using the fewest possible resources (d) legally, within the scope of practice/policy.
• Establish and/or revise priorities based on: (a) urgency of the patient or organizations need (b) resource availability (c) predetermined schedules (d) other department/personnel expectations.
• Ensure activities are prioritized to achieve desired results.
• Seeks direction when lack of clarity exists to maximize performance.
• Meets team goals by ensuring individual actions are aligned with the team needs.
• Demonstrates knowledge of NCQA and HEDIS Standards.
• Establish and maintain effective relationships with customers and gain their trust and respect.
• Provide clinical oversight for LVNs or SWs as needed within RN Nursing Guidelines (may include but not limited to medication reconciliation).
• Additional duties as assigned to meet business needs.