Care Manager (RN)

Job Title: Care Manager (RN)
Duration: 2+ Months
Fully remote- can sit anywhere in the US but must have a CA RN license and be able to work PST hours listed
Shift: 8-5 Mon-Friday
Can work at 7am if needing an earlier shift

Job details: 

• 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 an clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
 
Licenses/Certifications: Current state’s RN license.

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

Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience:
Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.

License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure requiredEvaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome

Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs

Identifies problems/barriers to care and provide appropriate care management interventions

Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services

Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs

Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate

Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services

May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned

Complies with all policies and standards 

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: $50.62/daily.