This is a remote position with expected travel of 50-75% using your own vehicle to meet with members face to face in SANGOMON, MONTGOMERY, MACOUPIN COUNTIES IN IL,
Strongly prefers qualified candidates located in Sangamon, Montgomery, Macoupin counties of IL.
Schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST.
Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
- Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
- Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to company's programs and plans.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
- Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assessments include the member's level of work capacity and related restrictions/limitations.
- Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
- Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
- Utilizes case management processes in compliance with regulatory and company policies and procedures.
- Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Required Qualifications:
- Minimum 3 years of clinical practice experience required.
- Current Active unrestricted RN licensure in the state of IL required.
- Willing and able to travel 50-75% of their time using their own vehicle to meet members face to face in Sangamon, Montgomery, Macoupin counties IL and surrounding areas.
--Minimum 1 year experience in MS office suite applications including Word, Excel and Outlook
Preferred Qualifications:
-Case Management in an integrated model preferred.
- Experience working with adults with Behavioral Health needs preferred.
- Long Term care experience in Nursing Home setting preferred
