RN Case Manager - Remote

Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 committed to positively impacting the lives we touch. The company has a culture of inclusivity and human kindness, based in Phoenix, AZ, with satellite locations in multiple states. APH has been recognized the last two years as one of “America's Fastest-Growing Private Companies” by Inc. 5000 and has earned a "Best Places to Work" award from the Phoenix Business Journal four years in a row. As one of the country's few fully integrated healthcare providers, APH offers a range of services which include case management, in-home/in-clinic wellness assessments, preventative care, transitional care, and social work services. APH offers customized services for Medicaid, Medicare, and the ACA/Marketplace lines of business.

The RN Case Manager is responsible for assessing patient/family psychosocial needs, planning, implementing, procuring services for, and evaluating care needs. As an RN CM, you’re focused on improving quality of life and health literacy. Coordinates, monitors, and ensures that appropriate and timely primary, acute, and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, and monitors healthcare resources within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for members. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member while collaborating with the treatment team to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the member. As an RN CM, you will be expected to work typical business hours, Monday-Friday, 8a-5p. You will have the ability to operate remotely if you reside in one of the following states: AL, AZ, FL, IL, KY, MN, MO, NE, NC, NM, NV, NY, OR, TN, TX, UT, VA, WA, WI, WV, or WY.

Evaluates members for case management services and determines the appropriate level of care coordination and management services for member. Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate members' need for alternative services. Acts as a primary case manager for all assigned SNP members. Develops and monitors members' plans including progress toward meeting established goals and self-management activities. Interacts with members, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and status. Assess the options for care including the use of benefits and community resources to update the care plan. Ensures facilitation, collaboration, and coordination with the care team. Acts as a resource for staff (i.e., Care navigators and LPN case managers) Act as liaison and member advocate between the member/family, physician, and facilities/agencies. Maintains accurate records of case management activities in the EMR using clinical guidelines. Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information, and reports critical incidents and information regarding the quality-of-care issues. Ensures compliance with all state and federal regulations as well as corporate guidelines in day-to-day activities. Adapts to changes in policies, procedures, new techniques, and additional responsibilities. Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds. Performs other related duties as assigned by management.