Required skills & experience:
1. Active, unrestricted RN (BSN preferred) license in California (Willingness to obtain additional state licenses as needed)
2. Utilization knowledge on Part A, Part B and part D Medicare.
3. Medicare/ Medicare Advantage experience is strongly preferred, but if no Medicare Advantage experience then candidate needs to have Complex/Case Management experience.
4 Knowledges of HEDIS
5. Two years case management at a managed care plan or provider organization and knowledge of the evidence based guidelines for the main chronic conditions-HTN, CAD, Heart Failure, Diabetes, CKD and COPD.
6. Ability to understand CMS guidelines
7. Understanding of the basic principles for OSHA, CLIA, HIPAA and AHCA.
What you need to know:
• RN has to be bilingual
• This location covers mostly Orange County
• Adaptability is key. Oscar moves quickly and things change. Candidate must be able to adapt and pivot.
• RN must be Self-motivated---this role is remote and this role requires RN to be able to keep themselves motivated and on track with daily responsibilities.
• The assigned Registered Nurse (RN) will operate within the company’s Clinical Care Delivery department providing onsite and telephonic care management services to Medicare Advantage individuals identified as “high risk members”.
• Serve as the primary point-of-contact for a selected group of Medicare Advantage members and their families.
• Will travel between the office, member's homes and acute and subacute facilities.
• Will participate in twice weekly meetings with Medical Director to review member’s progress, update the plan of care as needed.
• Works in collaboration and continuous partnership with chronically ill or "high-risk" patients and their family/caregiver(s) in a team approach to:
-Reduce emergency room utilization and hospital readmissions.
-Promote timely access to appropriate care.
-Increase utilization of preventative care.
• Initiates onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team.