JOB SUMMARY

The role of the Case 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 Case Manager is responsible for providing patient centered care across the care continuum.

DUTIES & RESPONSIBILITIES

The Case Manager, RN job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Assessment of the medical, social, and behavioral needs of an assigned population.
• Care Plan development and prioritization to transition members to optimal levels of health and self-management.
• Coordinate interdisciplinary team meetings as required.
• Collaboration 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 settings.
• Ensure member communication and notices are composed in a manner consistent with regulatory standards.
• Adheres to the Policies and Procedures set forth by the Quality Management Committee.

EDUCATION AND PROFESSIONAL EXPERIENCE

• RN License for California required
• Bilingual English and Spanish is a plus
• Minimum two (2) years of experience in medical management clinical functions
• Working knowledge of MCG, InterQual, and NCQA standards
• Active License as a Registered Nurse (RN)
• Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred

PROFESSIONAL COMPETENCIES

• High level of critical thinking and problem-solving skills
• Strong work ethic and overall positive attitude
• Effective communication skills including verbal and written
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
• Demonstrated flexibility, organization, and self-motivation
• Highly adaptable to change

For individuals assigned to a location(s) in California, NeueHealth is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $65,745-$98,617 annually.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays.