Remote Complex RN Case Manager, Advantage Plus Network of CT

Position Details:

• Location: Telecommuter position, possible travel to Farmington, CT for training/meetings
• Department: Case Management
• Schedule: Full time, 40 hours/weekly, Monday through Friday, 8:00AM - 4:30PM

Primary Responsibilities:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
• Member Care Coordination
• Collaborates with physicians and multidisciplinary teams to develop and maintain up to date, coordinated care plans
• Acts as a liaison between members and the healthcare team to ensure effective communication and alignment of care plans
• Member Referral Support
• Assists physicians, members, and families in obtaining referrals to specialists
• Provides counseling and support tailored to the clinical needs of the member
• Care Plan Development
• Creates comprehensive member-centric care plans that include member-driven goals and interventions
• Partners with designated physicians to create and maintain individualized Member Care Plans
• Clinical Improvement
• Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience for both referred members and referring physicians
• Liaison Role
• Facilitates communication among care team members to address the needs of both the member and the physician
• Provider/Member Education
• Provides education to member on health management and maintenance for optimal health outcomes
• Educates members and care team participants about available community and health plan benefits and services
• Performs additional tasks as assigned to support the overall goals of the Medical Management department
• Physical & Mental Requirements:
• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Bachelor of Science in Nursing (BSN), or 5+ years case management experience in lieu of BSN
• Unrestricted current RN licensure in state of Connecticut
• 2+ years experience in health plan case management, complex and disease case management
• Experience in a remote and telephonic role
• Proficient in Microsoft Office and Adobe products
• Ability to travel to Farmington, Connecticut as necessary for training, meetings, or as requested by supervisor/manager

Preferred Qualifications:

• Master's Degree in Nursing (MSN)
• Certified Case Manager Certification (CCMC)
• Case management experience serving community based members residing in Connecticut
• Experience in discharge planning
• Experience in utilization review, concurrent review, or risk management
• A background in managed care
• Ability to work on a multi-disciplinary team
• Proven solid critical thinking and decision-making skills
• Proven excellent interpersonal and communication skills (both written and oral)
• Bilingual with English and Spanish, Polish, Mandarin, or Vietnamese

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Apply tot his job Apply To this Job