Registered Nurse Case Manager - Health Plan

Job Summary:
Pro Staff Group LLC has a local client in need for an RN Case Manger - works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Staff works to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge/Skills/Abilities:

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Conducts face-to-face or home visits as required.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for members
• Facilitates interdisciplinary care team meetings and informal ICT collaboration.
• Uses motivational interviewing and clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• 25- 40% local travel required.
• RN's provide consultation, recommendations and education as appropriate to non-RN case managers.
• RN's are assigned cases with members who have complex medical conditions and medication regimens
• RN's conduct medication reconciliation when needed.
   

Job Qualifications:
Required Education

• Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred.

Required Experience

• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

• Bachelor's Degree in Nursing

Preferred Experience

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

• Certified Case Manager (CCM)

Pro Staff Group LLC holds key relationships with many of the nation’s leading health insurance and hospital systems. From Case Management, Appeals/Grievances, AP/AR departments as well as LPN/CNA and other clinical/non-clinical jobs – clinicians and non-clinicians alike can turn to ProStaff Group LLC for the opportunities that match their career goals.
 

Pro Staff Group LLC is the industry leader in local contract and travel healthcare staffing services, matching qualified clinicians and healthcare professionals with thousands of temporary, travel and local assignments, as well as permanent allied career opportunities.