Care Manager, RN (Work From Home)

We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

The role of the Care Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Care Manager is responsible for providing patient centered care across the care continuum.

Assessment of the medical, social, and behavioral needs of an assigned population Provide Care Plan development and prioritization to transition members to optimal levels of health and self-management. Coordinate interdisciplinary team meetings as required Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population Provide transition of care interventions as required Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population. Facilitate linkage to appropriate community resources to address social determinants of health Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting Able to ensure member communication and notices are composed in a manner consistent with regulatory standards. Adhere to the Policies and Procedures set forth by the Quality Management Committee.