Network Health Administrative Services, LLC
RN Care Manager - Dual Eligible Plans
Network Health Administrative Services, LLC, Menasha, Wisconsin, United States, 54952
The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes.
Location:
Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.
Hours:
1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies
Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved
Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff
Evaluate and process member referrals from physicians to other specialty providers
Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met
Works with members and families on self-management approaches using coaching techniques such as motivational interviewing
Educate the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes.
Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality.
Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
Stay abreast of current best practices and new developments
Other duties as assigned
Job Requirements:
Graduation from accredited school of nursing
Bachelor's degree in Nursing preferred
RN licensure in the State of Wisconsin
Case Management certification preferred
Four years of clinical health care experience as a RN required
Previous experience in case management, utilization management, insurance, or managed care preferred
Experience with Medicare, Medicaid required
Network Health is an Equal Opportunity Employer
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.
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Location:
Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.
Hours:
1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies
Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved
Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff
Evaluate and process member referrals from physicians to other specialty providers
Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met
Works with members and families on self-management approaches using coaching techniques such as motivational interviewing
Educate the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes.
Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality.
Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
Stay abreast of current best practices and new developments
Other duties as assigned
Job Requirements:
Graduation from accredited school of nursing
Bachelor's degree in Nursing preferred
RN licensure in the State of Wisconsin
Case Management certification preferred
Four years of clinical health care experience as a RN required
Previous experience in case management, utilization management, insurance, or managed care preferred
Experience with Medicare, Medicaid required
Network Health is an Equal Opportunity Employer
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr