Case Manager II RN - AUSTIN (HYBRD REMOTE)

Job Description

***REMOTE IN AUSTIN***

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

• 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

Qualifications - External

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

· Outreach members by phone to review their needs following recent discharge, and to complete a medication reconciliation.

· Outreach PCP offices to obtain a verbal medication list to complete a medication reconciliation on an unable to reach member.

· Refer members to traditional CM teams as needed.

· Complete a Transition of Care Assessment with member via phone calls.

· Outreach members in different time zones throughout the US, from east coast to west coast.

Describe the performance expectations/metrics for this individual and their team:

· Assignment to include 20-30 tasks per day; minimum of 11 successful TOC/MRP assessments per day; audits of 90% or higher

Tell me about what their first day looks like:

· System specific training to learn the navigation of the system and where to document the information.

What previous job titles or background work will in this role?

· Previous experience as a telephonic CM. Other experiences that would benefit include: Home Health, ER/triage, Case Management, and adult care.

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.

Licenses/Certifications: Current state’s RN license.

*Pediatrics - birth to 21

*Work-from-home case management role

Compact licensure is needed. CA and OR RN licensures would also be a benefit if the candidate has those. To further explain, my case management team is a specialty team. Our focus is calling Medicare members all over the US within 30 days from a hospital, rehab, or any other inpatient stay to follow up on any pending needs they have and to review their most recent medication changes follow the discharge. We then send a medication reconciliation to their PCP via fax. All work is done remotely, Mon-Fri, 8a-5p. It’s call after call, so I need someone that is willing to make quite a few calls each day.Company Description

Media Riders Inc is a family-owned Recruitment and Staffing Services company. Providing recruitment and payroll services to our customers, who directly support State and/or Federal funded programs. We are an SBA certified Women-Owned Small Business (WOSB) and Texas certified Historically Underutilized Business (TxHub).