The Telephonic Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Telephonic Care Manager work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Telephonic Care Manager employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
While this is a work at home position, the expected working hours are located in the Pacific Time zone, and the individual in this role is expected to already have a current, unrestricted CA nursing license.
Active Registered Nursing license in the state of California
A minimum of 2 years of prior Case Management experience working with Medicare members and seniors
At least 3 years of varied clinical nursing experience
Proficient with Microsoft Office products including Word, Excel and Outlook - plus general knowledge of working with computers and electronic medical records
Ability to work independently under general instructions and with a team
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
Prior experience working with CA IPA's or HMO's a plus
Active RN license in NV
Experience with discharge planning and patient education for adult acute care
Knowledge of MCG/Milliman or Interqual
Managed care experience
Certified Case Manager (CCM)
Scheduled Weekly Hours