Care Manager (Remote)

Education Level: High School Diploma or GED Licenses/Certifications: RN - Registered Nurse - State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC Upon Hire Required Accredited Case Manager (ACM): Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment upon hire preferred or CCM - Certified Case Manager: Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment upon hire preferred. Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience. Preferred Qualifications: Bachelor's degree in nursing CCM/ACM or other RN Board Certified certification in case management. Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment. Previous experience working with a Healthcare payor organization. Knowledge, Skills and Abilities (KSAs): 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.

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