SWHR CIN Care Manager Registered Nurse (RN) - Full Time - Monday-Friday - 8:00am-5:00pm - Remote Position
Thanks for your interest in the SWHR CIN Care Manager Registered Nurse (RN) - Full Time - Monday-Friday - 8:00am-5:00pm - Remote Position position.
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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.