Resp & Qualifications
The Nurse Care Manager is primarily responsible for identifying Trusted Health Plan members appropriate for targeted, high touch community-based integrated care coordination services. The Case Management/Care Coordination (CM/CC) program utilizes a member/family center approach that provides comprehensive case management services to the highest risk health plan members.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The Nurse Care Manager focuses on optimizing Trusted Health Plan members to achieve their highest level of functionality, comfort, energy, independence, and freedom from health risk to enjoy the highest quality of life.
The Nurse Care Manager compiles a comprehensive care management assessment (Health Risk Assessment – HRA) and gathers pertinent information about the members needs by interviewing the member, appropriate family members, physicians, ancillary health professionals and others as necessary.
Individual precision plans of care are developed in collaboration and cooperation with the Member/Care Giver, Physician, Ancillary Health Professionals, Families and others on the Care Team (pharmacist and social worker). Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically or electronically through email, among members and Providers.
Nurse Care Manager duties include but are not limited to:
• Documenting members’ care management plans and on-going activities
• Identifying and addressing member risk factors and/or obstacles to care
• Identifying member needs, current services, and available resources, then connecting the member to services and resources to meet established goals
• Communicating the care preferences of members, serving as their advocate, and verifying that interventions meet the member’s needs and goals of treatment
• Screening members and/or population for healthcare needs
• Developing a member-focused care management plan
• Educating the member/family/caregiver about the care management process and evaluating their understanding of the process
• Participate in weekly case review to learn and share opportunities to improve outcomes.
Clinical knowledge and experience to bring an understanding of the clinical process of compiling the information of the HRA, planning, implementation, and evaluation to the process of care management. In addition to clinical expertise, care management nurses need excellent communication and problem-solving skills and must know how the health care system works, including regulations, resource availability, and the coverage of medical care.
Active and unrestricted RN License Certification in Case Management preferred
Bachelor's Degree in related Health/Nursing field preferred
A minimum of two years of experience in health care, case management, care coordination, discharge planning or utilization management
Experience working with case management data systems
Experience working in a managed care environment preferred Proficient in Microsoft Office tools
Should have a high level of understanding of community resources, treatment options, home health availability, funding options and special programs
Department: DC Medicaid
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 8.22.2020
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.