RN Care Manager

Job Title:

RN Care Manager

Job Description

The RN Care Manager provides comprehensive clinical assessment, develops member-centered care plans, and delivers ongoing care coordination for program members, including older adults and individuals with intellectual or physical disabilities. This role focuses on achieving meaningful member outcomes through adherence to standards of care and best practices, while ensuring services are delivered with respect, compassion, integrity, and a strong commitment to quality.

Responsibilities

+ Perform discipline-specific initial and ongoing comprehensive clinical assessments for program members.

+ Develop, implement, and maintain individualized, member-centered care plans that support health, independence, and quality of life.

+ Use critical thinking to optimize members health and quality of life and help them reach their personal goals.

+ Coordinate care and services across providers, facilities, and community resources to ensure seamless support for members.

+ Conduct home visits and home assessments as needed, gathering additional information by consulting with families and other supports.

+ Interact with members and their families with the highest level of respect, compassion, and integrity in all communications and visits.

+ Educate members and families about care plans, available services, and strategies to manage health conditions and maintain independence.

+ Adhere to standards of care, best practices, and operational standards to achieve member outcomes and organizational goals.

+ Comply with contractual, regulatory, and internal policy requirements and expectations in all aspects of care management.

+ Participate in quality assurance activities and monitoring of services to ensure high-quality member care and continuous improvement.

+ Identify and participate in initiatives to continuously improve the quality of member care, services, and internal processes.

+ Foster a member-centered culture on a daily basis by advocating for member needs and preferences in care planning and coordination.

+ Participate in efforts to enhance work experiences for colleagues and contribute positively to team culture.

+ Actively seek and participate in training and professional development opportunities to maintain and grow clinical and care management expertise.

+ Support the achievement of operational goals by effectively managing caseloads and documentation within healthcare management systems.

+ Collaborate with interdisciplinary team members, including social work, psychology, and human services professionals, to support holistic care.

+ Utilize healthcare management systems and processes for case management, prior authorization, and care plan documentation.

+ Ensure accurate, timely documentation of assessments, care plans, member interactions, and service coordination activities.

Essential Skills

+ Active LPN or RN degree with a valid Wisconsin nursing license.

+ LTC Functional Screener or Certified Functional Screener credential for Wisconsin.

+ At least 2 years of care management experience in a healthcare or long-term care setting.

+ Demonstrated experience in case management and care coordination for diverse populations, including older adults and individuals with disabilities.

+ Knowledge of Medicare, Medicaid, and managed care programs, including Badger Care and other Wisconsin-specific programs.

+ Ability to develop, implement, and maintain individualized care plans that are member-centered and outcomes-focused.

+ Strong clinical assessment skills and the ability to perform comprehensive assessments in home and facility settings.

+ Proficiency using healthcare management systems for documentation, care planning, and prior authorization processes.

+ Ability to apply critical thinking to clinical situations to optimize member health and quality of life.

+ Strong communication skills for interacting with members, families, and interdisciplinary team members with respect and clarity.

+ Ability to travel within assigned counties to conduct in-home and long-term care facility visits.

+ Commitment to adhering to standards of care, regulatory requirements, and internal policies.

Additional

Skills & Qualifications

+ Collaborative experience in social work, psychology, or human services.

+ Experience working within the broader healthcare industry and managed care environments.

+ Familiarity with Wisconsin county-based services and long-term care programs.

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Experience with prior authorization processes and healthcare…