RN Care Manager - Dual Eligible Plans (1.0 Fte)

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a RN Care Manager who will provide case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The ideal candidate would have prior experience working in the emergency department, inpatient medicine or chronic disease management experience. 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.

The position is eligible to work remotely out of your home office in the state of Wisconsin. Travel to the corporate office will be required occasionally for the position.

Job Responsibilities:

• Screens candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and time frames for re-assessment using evidence-based clinical guidelines. Evaluates and determines member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies.

• Reviews results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; closes cases when expected goals/outcomes are achieved.

• Provides information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff

• Evaluates and processes member referrals from physicians to other specialty providers

• Assess, plans, facilitates and advocates 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

• Educates 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.

• Facilitates 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.

• Schedules visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.

• Stays abreast of current best practices and new developments

• Other duties as assigned

Job Requirements:

• Graduation from accredited school of nursing

• RN licensure in the State of Wisconsin

• Bachelor's degree in Nursing preferred

• Four years of clinical health care experience as a RN

• Previous experience in case management and care coordination, social determinants of health, with a focus on transition of care, chronic care management, or inpatient/emergency room experience.

• Experience with Medicare, Medicaid and other insurance preferred

• Active and valid driver's license

Network Health is an Equal Opportunity Employer. We encourage applications from all backgrounds, communities and industries, and are committed to having a team that is made up of diverse skills, experiences and abilities. We are committed to equality and diversity within Network Health.

• WARNING: Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that Network Health recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our positions require that you first complete an online application.