Case Manager

Overview

• Provide comprehensive case management services remotely, supporting members in achieving optimal health outcomes.
• Collaborate with multidisciplinary teams to develop member-centric care plans tailored to individual needs.
• Utilize clinical expertise to perform assessments and coordinate resources effectively.
• Monitor and manage member progress, modifying plans as needed to ensure positive outcomes.
• Educate members on proactive health interventions to promote wellness and limit expenses.
• Document all aspects of case management, from initial assessment to outcome evaluation.
• Engage with high-risk members to provide targeted support and alternative treatment plans.
• Develop policies, procedures, and training materials to enhance case management practices.

Key Responsibilities & Duties

• Coordinate care and resources for members to achieve optimal clinical outcomes.
• Perform comprehensive assessments to identify member needs and barriers to care.
• Develop and implement tailored care plans utilizing community resources and funding sources.
• Monitor member progress and modify care plans to address changing needs.
• Facilitate care across the continuum, including physician offices, hospitals, and home care.
• Educate members on health interventions to encourage proactive care management.
• Document case management activities comprehensively and accurately.
• Outreach to high-risk members to provide specialized support and evaluate treatment plans.

Job Requirements

• Bachelor of Science in Nursing (BSN) required; valid RN license (NC or compact multi-state).
• Minimum of 3 years of clinical or case management experience; 5 years preferred.
• Specialty certification (e.g., CCM, CDCES) required within 2 years of employment.
• Proficiency in developing and implementing member-centric care plans.
• Strong documentation skills to ensure accurate record-keeping and compliance.
• Ability to utilize community resources effectively in care planning.
• Experience in monitoring and modifying care plans based on member progress.
• Knowledge of healthcare policies and procedures to support case management activities.