RN Care Manager

The Registered Nurse Care Manager provides 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 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.

Job Responsibilities:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies
• Screens candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes 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
• Bachelor's degree in Nursing preferred
• Four years of clinical health care experience as a RN
• Previous experience in case management, utilization management, insurance, or managed care preferred
• Experience with Medicare, Medicaid preferred
• May require four (4) years of behavioral health experience.
• RN licensure in the State of Wisconsin
• Case Management certification preferred.

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

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.