Care Manager (Remote

Resp & Qualifications

This role requires candidates to be located in the Maryland, Washington, DC, or Northern Virginia (DMV) area.

This position will support the Medicare Advantage line of business. Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioralhealth needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.

The ideal candidate will have previous experience with Medicare and/or Medicare Advantage patient populations with multiple co-morbidities, complex needs, social determinants of health and/or barriers to care.

We are looking for an experienced Registered Nurse to work remotely within the greater Baltimore/Washington metropolitan area. While this position is remote, the incumbent will be expected to come into a Care First location periodically for meetings, trainings and/or other business-related activities.

• Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to develop a comprehensive plan of care to address the member's needs at various stages along the care continuum. Identifies relevant Care First and community resources and facilitates program, network, and community referrals.
• Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member's medical, behavioral and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self-manage.
  
  Ensures member data is documented according to Care First application protocol and regulatory standards.

Education Level: High School Diploma or GED.

• RN
  - Registered Nurse - State Licensure And/or Compact State Licensure RN
  - Registered Nurse in MD, VA or Washington.

Experience:

5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.

• Bachelors degree in nursing
• CCM/ACM or other RN Board Certified certification in case management.
• Previous experience with Medicare and/or Medicare Advantage patient populations with multiple co-morbidities, complex needs, social determinants of health and/or barriers to care.
• Skilled in typing and working within various web-based platforms

• Knowledge of clinical standards of care and disease processes.
• Ability to produce accurate and comprehensive work products with minimal direction.
• Ability to triage immediate member health and safety risks.
• Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
• Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
• Knowledgeable of available community resources and programs.
• Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.
• Ability to provide excellent internal and external customer service.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

$72,360 - $143,715

The disclosed range estimate has not been adjusted…