The Care Management program provides Registered Nurses with expertise in geriatric care and experience working in multidisciplinary teams, the ability to make a difference in people's lives. While there are many goals of this program, the overriding goal is to improve the member's quality of life by reducing unnecessary hospitalizations and emergency room visits. This position is a combination of working from home and field work.
RN license in good standing in the applicable states
Bachelor's degree preferred
2 years Case Management, Utilization Management or Transitional Care experience
Case Management certification preferred
Basic Life Support Certification required
Knowledge of clinical procedures, standards and quality control checks
Critical thinking skills
Excellent oral and written communication skills
Strong knowledge of medical conditions, interventions, treatment and medications
Ability to effectively present information and respond to questions from managers, employees, members and facility staff
Ability to adapt and be flexible in a dynamic environment
Ability to self-motivate and work independently with limited supervision
Strong organization and time management skills
Strong assessment skills to recognize urgent/emergent situations and respond appropriately
Collaborative and team-oriented approach to healthcare delivery services
Prompt, responsive and flexible with a passion for patient care
Experience working with culturally diverse populations
Expertise in geriatric care
Proficient computer skills, including working knowledge of Microsoft Office Suite, Outlook, EMR, and web-based programs
Ability to obtain unrestricted licensure in required states
Ability to effectively present information and respond to questions from members, providers, team members, and managers
Ability to adapt to rapidly changing technology and apply to job responsibilities
Ability to handle routine tasks
Self-directed and organized
Sound judgement in handling/escalating difficult situations
Sense of urgency
Good interpersonal and conflict resolution skills
Discrete (i.e., ability to maintain confidentiality)
Ability to work under pressure
Ability to take direction
Customer Service Driven
Work effectively with frequent interruptions
Essential Job Responsibilities:
Responsible for case management of assigned members including assessment, planning, implementation, coordination, monitoring and evaluation.
Conduct regular telephonic and/or in person follow-up with members and/or caregivers, as well as appropriate medical staff based on care needs identified during face-to-face clinical assessments performed by the field Nurse Practitioner(s).
Partner with the Signify Health Nurse Practitioner, member's health plan, and outside providers to help coordinate both internal and external resources to meet the member's identified needs and to manage the member's Plan of Care.
Collaborate with the field Nurse Practitioner(s) to quickly respond to urgent/emergent conditions to ensure that the member receives the appropriate care in the appropriate setting.
Weekly rounding with the Signify Health Care Management team and health plan team, as required.
Assist with process improvement and commits to focusing on continuous improvement of workflow processes and procedures.
Supports and implements organizational technology changes.
Attends meetings, training sessions, and participates on committees as requested.
Knowledge of clinical procedures, standards, and quality control checks.
Provides member, caregivers, and facility education.
Performs triage assessment when needed.
Responds effectively to /member/Caregiver/provider/health plan phone calls.
Assists facility/member/Caregiver in scheduling appointments with specialists.
Monitors the quality of member's care and updates Plan of Care.
Provides back up support and training for other clinical team members, as needed.
Identifies / implements cost-effective approaches and interventions.
Provide education/training for providers, when applicable.
Performs other related duties and responsibilities as assigned.
Additional Job Responsibilities:
Participate in staff meetings, conference calls, and other meetings, as needed
Complete reports as requested
Assist/coach/coordinate with other team members
Attend training sessions to acquire/enhance skills related to programs offered
Maintain a neat, orderly work area
Perform other incidental and related duties as required
Requires ability to use a phone, computer, and iPad.
Requires the ability to also conduct in-person visits in the field
Normal sight and hearing ability
Use office equipment and machinery effectively
Ability to ambulate to various parts of the building
Ability to bend, stoop
Work effectively with frequent interruptions
May require occasional overtime to meet project deadlines
Lifting requirements of 15 lbs. occasionally