Job Information
CAI Case Manager, RN in Olympia, Washington
Job ID Number
R3709
Employment Type
Full time
Worksite Flexibility
Remote
Job Summary
As Case Manager, you will assist in the holistic assessment, planning, arranging, coordinating, monitoring, and evaluation of outcomes and activities necessary to facilitate member access to healthcare services.
Job Description
We are looking for a Case Manager, RN . This position will be full-time and remote .
What You’ll Do
Communicate effectively while performing customer telephonic interviewing and communication with external contacts
Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts
Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States
Educate members, (with approved websites including Healthwise connect) in order to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes
Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care
Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs
Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member
Develop an individualized plan of care designed to meet the specific needs of each member
Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated
Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services
Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention in order to develop a realistic plan of care
Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination
Maintain a working knowledge of available community resources available to assist members
Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible
Work within a Team Environment
Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services in order to enhance professional knowledge and competency for overall management of members
Participate in departmental and/or organizational work and quality initiative teams
Case collaborate with peers, Case Management Specialists, Management Team, Physician Advisors, and other interdepartmental contacts
Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources
Foster effective work relationships through conflict resolution and constructive feedback skills
Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable
Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served in order to foster constructive and collaborative solutions to meet member needs
Other duties as assigned or requested
What You'll Need
Required
Bachelor’s degree in nursing or RN certification and 3 years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations
3-5 years of experience in working in Acute Care/Managed Care
Preferred
Bilingual English/Spanish language skills
Case Management Certification
Physical Demands
Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state, and local standards
Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc.
Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor
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Reasonable Accommodation Statement
If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@cai.io or (888) 824 – 8111.
Equal Employment Opportunity Policy Statement
It is the policy of CAI not to discriminate against any employee or applicant due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Employees and applicants of CAI will not be subject to harassment due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited.