RN Case Manager

Job Summary: 

Under the supervision of the Case Management Program Manager, the Case Manager (CM) is responsible for providing case management services for medically and/or socially complex members. The target member population includes individuals with significantly complex medical conditions, and/or social-economic, or mental health needs. The goal of the program is to assist these members in achieving optimal health and/or independence in managing their care. To achieve this goal the Case Manager will demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient-centered, culturally sensitive care coordination, and management of complex members. The Case Manager will adhere to the CMSA Standards of Practice for Case Management.

The Case Manager is responsible for developing comprehensive care plans for member and family self-care competence, including motivational assessment, assessing for desired level of involvement, and coaching for adherence to the care plan. The CM assesses the member’s needs, and creates and monitors a specific individualized care plan, including end of life planning. The CM promotes knowledge of the Case Management program to Prominence Health Plan contracted physicians, as well as members.  In addition, s/he is responsible for developing and sustaining partnerships with community resources and support agencies.

Qualifications and Regulatory Requirements:

• Graduation from an accredited nursing education program, BSN or MSN preferred; OR BS/MS in Public Health or related field
• Active, unrestricted license as a Registered Nurse in the state in which the CM practices
• Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), or ability to obtain within the required time period
• 3 yrs minimum Case Management experience in a managed care environment required
• Recent (within past 3 years) working knowledge of Milliman Care Guidelines required
• 3 yrs minimum clinical medical/surgical nursing practice within a hospital setting
• Ability to effectively communicate in English and Spanish, both verbally and in writing required
• Experience working with the Medicare and Medicaid population segment preferred
• Knowledge of Medicare/ Medicaid processes and compliance standards

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

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