Job Posting for RN Care Manager (Hybrid) at Centers Plan for Healthy Living/Centers Care Solutions
Care Solutions is seeking RN Care Manager
Join the excitement in support of our MLTC and Medicare Advantage Plan businesses!
Centers Care Solutions (CCS), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CCS is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community
The Care Manager works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Through interventions such as complex case management and utilization management, the care manager will ensure coordination of health care services, member education, and preventative interventions.
PRIMARY RESPONSIBILITIES:
Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member’s care.
Initiates utilization review for preauthorization and post service reviews
Utilizes knowledge of community resources and the member’s benefit structure
Interacts with providers and facilities in a professional, respectful manner
Recognizes quality of care issues and escalates the issues appropriately
Assists members with the coordination of services from various settings as appropriate
Complies with all CCSs standards for documentation
Participates in case rounds
Participates in on call coverage
Participates in other meetings as requested
Participates in quality improvement initiatives
Other duties as assigned
Required:
Active and unrestricted RN license
Strong written and verbal communication skills
Preferred:
Bachelor of Science in Nursing
CCM certification
Knowledge of Milliman or InterQual criteria
Experience providing care in the home setting
Experience working within a managed care environment
We Offer
Hybrid Schedule (for employees who qualify)
Office Based Positions
Competitive Wages
Health Benefits
Dental Insurance
Vision Insurance
Generous Paid Time Off
Voluntary Employee Benefit Programs
401K
Life Insurance
Referral Award Program
Paid Training
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