Title: Clinical - Care Manager II (RN) Duration: 03 Months Remote - TX Monday – Friday 8 AM – 5 PM
Licenses/Certifications: Current state’s RN license.
Description -
Position Purpose: Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
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 and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications: Current state’s RN license.
Texas Requirements: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting. 2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.
Licenses/Certifications: Current state’s RN license. For New Hampshire Healthy Families: Candidates with active RN license in good standing in other states than NH, must obtain the NH RN equi within 90 days of hire. Active driver’s license in good standing preferred. CCM preferred.
For Arizona Complete Health - Complete Care plan: Pediatrics assignments require 2+ years’ RN experience in pediatrics (clinical acute care, community or managed care setting) and 1+ year experience in care management Obstetrics (OB) assignments require 2+ years’ RN experience in OB (clinical, acute, community or managed care setting) and 1+ year experience in care management Licenses/Certifications: Current state’s RN license.
For Buckeye Community Health Plan: 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 and 1+ years of case management or utilization experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Licenses/Certifications: Current state’s RN license.
• 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 • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes • 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 • 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. • Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems • Direct care to participating network providers • Perform duties independently, demonstrating advanced understanding of complex care management principles. • Participate in case management committees and work on special projects related to case management as needed • For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required
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.
