You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members.
You will report into the Associate Director, Clinical.
Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
Pay Transparency: The base pay for this role is: $39.28 – $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.
Responsibilities:
Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
Actively reach out to members undergoing difficult health challenges and develop care plans
Proactively reach out to hospital case managers to assist with discharge planning
Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures.
Compliance with all applicable laws and regulations
Other duties as assigned
Requirements:
Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
Ability to obtain additional state licenses to meet business needs
2+ years of clinical experience to include payer, hospital, outpatient or community based care management
1+ years of experience in Care Coordination and Navigation
Bonus points:
CCM Certification
Bilingual in Spanish and/or creole reading, writing, speaking
BSN
Working knowledge of Milliman Guidelines
SPECIALTIES:
Case Management (CM)
