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- Complete a Transition of Care Assessment with member via phone calls.
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- Assignment to include 20-30 tasks per day; minimum of 11 successful TOC/MRP assessments per day; audits of 90% or higher
- System specific training to learn the navigation of the system and where to document the information.
- Previous experience as a telephonic CM. Other experiences that would benefit include: Home Health, ER/triage, Case Management, and adult care.
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Clinical - Care Manager I (RN) - Round Rock, United States - Axelon Services Corporation
Description
8:00 AM 5:00 PM CSTNo overtime
Remote TX or any compact state.
Additional licensures: CA and/or OR licensures preferred to assist with west coast members.
Job Description: Description - External
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
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
Comments for Vendors: 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. Walk me through the day to day responsibilities of this the role and a description of the project
