Care Manager (RN)
Core
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Role type
Senior IC care manager (nursing)
Builds
Personalized care plans and service plans for Medicaid members
Domain
Healthcare / Medicaid / Social Determinants of Health
Required skills
Care plan development, provider coordination, resource identification, care gap resolution, member education, regulatory compliance, data documentation, social determinants of health assessment, telephonic outreach, home/site visits
Preferred skills
Time management, computer skills, organizational skills, fast-paced environment adaptability
Technologies
Electronic health records, telephonic platforms, digital outreach tools
Responsibilities
Evaluate member needs and barriers to accessing care; Develop ongoing care plans and collaborate with providers to identify specialists and community resources; Identify problems/barriers to care and provide appropriate interventions; Coordinate between members, families, and care provider teams; Provide ongoing follow-up and monitoring of member status and progress; Provide resource support for services like employment, housing, and independent living; Facilitate care management to ensure timely access to needed care; Perform telephonic, digital, home, and site outreach; Collect, document, and maintain member information for regulatory compliance; Provide education to members and families on disease processes and care options.
Seniority
Mid-level, hands-on IC