Field RN Case Manager - MLTC

Location: Charlottesville, VA
Date Posted: 02-01-2018
Long Term Case Management RN - Managed Care
Charlottesville, VA
*** This is a Full Time, Benefits Available, CONTRACT opportunity, expected to last 3 months or longer! ***
Your Job Summary:
As a member of the medical management team, the Case Manager works with members, providers and caregivers to provide intensive, comprehensive case management and increase efficient utilization of services; identifies chronic or catastrophic cases through the case management process and initiates intensive case management according to program guidelines. The goal of the Case Manager is to effectively manage patients on an outpatient basis to assure the appropriate level-of-care is provided, to prevent inpatient re-admissions and ensure that the patients’ medical, environmental and psychosocial needs are met over the continuum of care.  The Case Manager also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward a maximum level of independence.  The Case Manager works specifically with the member population eligible to receive benefits from both Medicare and Medicaid, called Dual-Eligible, also known as Special Needs Program (SNP).
Your Reward:  
This growing organization is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including Medical, Dental, and Vision Insurance, Flexible Spending Account (FSA) Program, Profit Sharing and 401(k), Basic & Supplemental Life Insurance, AD&D, Dependent Life Insurance, Short & Long Term Disability. They also have a generous PTO program with Vacation and Sick Leave, Paid Holidays, Flex work scheduling available, Vacation Sell-Back program, Tuition Reimbursement, Adoption Assistance, and other wonderful benefits!
Your Background: 
Valid, unrestricted state Registered Nurse (R.N.) license.
Certification in Case Management (CCM) is preferred.
Around 2-5 years’ clinical nursing experience in an acute care hospital.
At least 2-3 years’ experience in managed care case management / care coordination is required.
Previous work experience with behavioral health populations is preferred.
Experience working with vulnerable adults / seniors and low-income / disadvantaged populations is a plus
Demonstrate strong understanding of benefits from multiple federal & state programs, including Medicare and Medicaid.
Knowledge of community resources and/or previous work with vulnerable adults or senior population preferred.
Computer literacy (MS Office) and typing skills are necessary.
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Fully Bilingual in Spanish & English is a plus.
Your Duties:
The Nurse Case Manager will serve the daily case management needs of members. This includes administering all provider resources through the care continuum, from the initial referral through discharge and ensuring compliance with the plan of care. They will collaborate effectively with an interdisciplinary team to establish an individualized plan of care for members. A strong emphasis is placed on Wellness, Disease Management and patient/member education to ensure compliance with the plan of care and prevention of complications with various ailments. The Case Manager will develop interventions and processes to assist the Health Plan member in meeting short and long term plan of care goals.  They will coordinate member visits with providers and specialists as needed.  Communication of patient needs will be conducted through timely and accurate data entry into designated care management applications. The Case Manager will participate in the development of appropriate QI processes, establishing and monitoring indicators. Utilizing their knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms, the Nurse will help guide physicians in their awareness of preferred contracts, providers, and facilities. They will coordinate the approved services with all provider staff under the specific direction of the Medical Director or Manager of Medical Management.

443.552.7423 (CALL – TEXT – FAX)
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