Offer summary

Qualifications:

Associate’s degree in Nursing required, Bachelor’s degree preferred., Minimum two years of experience in medical management clinical functions., Active License as a Registered Nurse (RN) in California is mandatory., Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred..

Key responsabilities:

Assess the medical, social, and behavioral needs of an assigned population.

Develop and prioritize care plans to transition members to optimal health.

Coordinate interdisciplinary team meetings and collaborate across providers.

Facilitate care coordination, self-management planning, and linkage to community resources.

Job description

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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

SCOPE OF ROLE

The role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Case Manager is responsible for providing patient centered care across the care continuum.

ROLE RESPONSIBILITIES

Assessment of the medical, social, and behavioral needs of an assigned population
Care Plan development and prioritization to transition members to optimal levels of health and self-management.
Coordinate interdisciplinary team meetings as required
Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
Provide transition of care interventions as required
Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
Facilitate linkage to appropriate community resources to address social determinants of health
Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting
Ensure member communication and notices are composed in a manner consistent with regulatory standards.
Adheres to the Policies and Procedures set forth by the Quality Management Committee.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

Associate’s degree in Nursing, Bachelor’s degree preferred
Minimum two (2) years of experience in medical management clinical functions.
Working knowledge of MCG, InterQual, and NCQA standards

LICENSURES AND CERTIFICATIONS

Active License as a Registered Nurse (RN) in California
Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred

PROFESSIONAL COMPETENCIES

High level of critical thinking and problem-solving skills
Strong work ethic and overall positive attitude
Effective communication skills including verbal and written
Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
Demonstrated flexibility, organization, and self-motivation
Highly adaptable to change

For individuals assigned to a location(s) in California, NeueHealth is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $75,639.05-$113,458.57 Annually.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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