Complex Case Management Nurse

Oscar Health Insurance Orlando , FL 32801

Posted 3 months ago

The Complex Case Management Program is consistent with the case management industry guidelines: assessment, care planning, communication and coordination, education, empowering and advocacy. The goal of this program is to improve quality outcomes and optimize service utilization and cost.

  • The assigned Registered Nurse (RN) will operate within the company's Clinical Care Delivery department providing onsite and telephonic care management services to individuals identified as "high risk members"

  • Serve as the primary point-of-contact for a selected group of members and their families

  • Will travel between the office, member's homes and acute and subacute facilities

  • Will participate in twice weekly meetings with Medical Director to review member's progress, update the plan of care as needed

Primary Responsibilities

  • Obtains consent from the member/family for participation in Complex Case Management

  • Develops an outcome-based plan of care, based on the member's input and assessed member clinical and social needs with anticipated targeted dates for accomplishment

  • Evaluates expected outcomes and associated costs of the plan of care as well as any proposed alternative plan of care and makes necessary revisions

  • Initiates onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team

  • Conduct initial in-home or facility visit to engage and educate the member (and their family/caregivers) to the Complex Case Management program

  • Routinely conduct telephonic, in-home, and/or in-facility visits to monitor the member's adherence to their established care plans

  • Continuously coordinates, monitors, tracks and evaluates all care and services rendered to ensure that quality care is being delivered in the most appropriate setting

  • Routinely discuss members' care plans with the Medical Director to make adjustments as necessary

  • Manages transition of care ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member's health care status changes

  • Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker

  • Identifies and addresses pharmacological and DME needs of the members and facilitates consultations with the pharmacy department, as necessary

  • Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and specialist visits

  • Be available (during work hours) to take incoming phone calls from assigned members (phone expense TBD)

Requirements

  • Active, unrestricted RN or LVN (BSN preferred) license in Florida, Tennessee, or California

Willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)

  • Two years case management at a managed care plan or provider organization and

  • Excellent communication skills to effectively interact with members, families, and external healthcare providers

  • Ability to work effectively both on an individual basis and as part of a multidisciplinary team

  • Strong computer skills to maintain accurate and complete documentation in our Case Management record systems

  • Strong working knowledge of Milliman Care Guidelines

  • Highly organized and self-motivated to effectively manage multiple members

  • Adherence to all member privacy and confidentiality standards of practice (i.e. HIPAA)

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Overnight Asm Complex Management

Wal-Mart

Posted Yesterday

VIEW JOBS 8/17/2019 12:00:00 AM 2019-11-15T00:00 Drives the financial performance of assigned area by ensuring that sales and profit goals are achieved and implements plans to correct any deficiencies; and scheduling and training associates to meet the needs of the customers. Drives sales in assigned area by ensuring effective merchandise presentation, including accurate and competitive pricing, proper signing, inventory levels, cleanliness of the area; assessing economic trends and community needs; overseeing the stocking and rotation of merchandise, the removal of damaged or out-od-date goods; setting up, cleaning, and organizing product displays; securing fragile and high-shrink merchandise; and monitoring expenses within assigned area. Models, enforces, and provides direction and guidance to hourly Associates on proper Customer service approaches and techniques to ensure Customer needs, complaints, and issues are successfully resolved within Company guidelines and standards. Ensures compliance with Company policies and procedures by holding hourly Associates accountable; analyzing and interpreting reports; implementing and monitoring asset protection and safety controls; maintaining quality assurance standards; overseeing safety and operational reviews; developing and implementing action plans to correct deficiencies; and providing direction and guidance on executing Company programs and strategic initiatives. Provides supervision and development opportunities for hourly Associates in assigned area by hiring, training, mentoring, assigning duties, evaluating performance, providing recognition, and ensuring diversity awareness. Participates in community outreach programs, and encourages and supports hourly Associates in serving as good members of the community. Upholds the Company's Open Door Policy by meeting with Associates and listening to concerns, researching issues, reviewing Company policies and procedures, and providing resolutions for Associates, including proactively seeking out Associate comments and concerns by meeting with Associates in their work areas. Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications. Minimum Qualifications: 2 or more years of college; OR 1 year retail experience and 1 year supervisory experience; OR 2 years general work experience and 1 year supervisory experience For facilities that sell firearms, I acknowledge that the position for which I am applying will require successful completion of a firearms- specific Criminal Background Check (CBC) and Firearms Authorized Training. Will successfully complete all job required trainings and assessments. For facilities that sell only ammunition and have state specific requirements, I acknowledge that the position for which I am applying may require a current state issued Certificate of Eligibility. Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications. Leading project work streams, Supervising Associates Minimum Qualifications Minimum Qualifications: 2 or more years of college; OR 1 year retail experience and 1 year supervisory experience; OR 2 years general work experience and 1 year supervisory experience For facilities that sell firearms, I acknowledge that the position for which I am applying will require successful completion of a firearms- specific Criminal Background Check (CBC) and Firearms Authorized Training. Will successfully complete all job required trainings and assessments. For facilities that sell only ammunition and have state specific requirements, I acknowledge that the position for which I am applying may require a current state issued Certificate of Eligibility. About Walmart At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainability—and everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industries—all while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for? All the benefits you need for you and your family * Multiple health plan options * Vision & dental plans for you & dependents * Associate discounts in-store and online * Financial benefits including 401(k), stock purchase plans and more * Education assistance for Associate and dependents Frequently asked questions * On average, how long does it take to fill out an application? On average, it takes 45-60 minutes to complete your application for the first time. Subsequent applications will take less time to apply as our system saves some of your application information. Please note that some positions require the completion of assessments in order to receive consideration for that role. Those would take additional time. * Can I change my application after submitting? No, you cannot change your application after submitting, so please make sure that everything is finalized before you hit the submit button. * How do you protect my personal information? Processing of information on paper is minimal, and Walmart processes application information using an applicant tracking system (ATS). Access to the data within the ATS is restricted to authorized personnel, and the system itself is held to high security standards by Walmart. * What are the recommended Internet Browsers for applying for open roles? * Internet Explorer 8.0+ * Firefox 4.0+ * Safari 4.0+ * Chrome 12+ See All FAQs Recently viewed jobs Wal-Mart Orlando FL

Complex Case Management Nurse

Oscar Health Insurance