Care Manager (RN)

Job Title: Care Manager (RN)
Location: Remote (can sit anywhere in the US but must have a CA RN license and be able to work PST hours listed)
Duration: 2 Months (Potential to extend)
Shift: 8 - 5 pst Mon-Fri

Job Responsibilities:

• Must have a private space/work area due to sensitive information.
• Must be comfortable to be on phones at home
• Training is about 3-4 weeks and then they will work with Senior Case Managers to start ramping up
• Experience Working with Medicare/Medi-caid
• Assisting with Backlog-referrals from CA-members  sending referrals to case managers
• Will be Assigned 5-10 referrals daily.
• Ability to work in Fast paced environment
• Case Management exp required.
• At least 4 hours a day is spent on outbound phone calls-reaching out to members.
• Calls are recorded-will have audio audits.
• Data entry-tracking data
• Case load requirement is 75 active cases-(will be ramped up to this amt) Cases are 90 days.
• Excel (data entry-basic knowledge)
• True Care medical records system
• Must be able to navigate multiple systems.
• Pharmacy system, eligibility system, Workforce management
• Develop, assess and adjust, as necessary, the care plan and promote desired outcome
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs

• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsals, treatment and provider options
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Education/Experience:

• Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.

Licenses/Certifications:

• Current state’s RN license.

Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:				Preferred Skills/ Experience:
1.	Experience with Medicare/Medicare required			1.	Psych/Behavioral Health Background/Experience
2.	Case management experience			2.	Bilingual in Spanish
3.				3.
Education Requirement:		CA RN license		Education Preferred:
Software Skills Required:		MS Office
Required Certifications:				Required Testing:

 

About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $44.30/hr.