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Clinical - Care Manager (RN) - J01007
Mindlance
- 🇺🇸 United States
- Remote
- Manager or above
- 1 day ago
- CMS
- RN License
- EHR
1 day ago
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 required
For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL
For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel required
Responsibilities:
Evaluates 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.
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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| Story Behind the Need | ||
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Health Plan or Business Unit: AcariaHealth Specialty Pharmacy Team Culture: Collaborative, patient-centered, and results-driven, with a focus on delivering high-quality care and continuous process improvement. Surrounding Team & Key Projects: The team consists of nurse case managers, leaders, and subject matter experts dedicated to managing home infusion patients and ensuring the highest standard of care. Current key projects include preparing for the launch of a new platform, which requires updates to policies and work instructions, as well as conducting user acceptance testing (UAT). Purpose of This Team: To provide comprehensive care coordination for home infusion patients, ensuring optimal outcomes through clinical data management, effective communication with providers, and adherence to best practices. Reason for the Request: The additional Nurse Case Manager is needed to support the team’s increasing workload, allowing regular staff, including leaders and subject matter experts, to focus on essential strategic initiatives such as UAT, policy rewrites, and preparation for the new platform launch. Motivators for This Need: To maintain a high standard of patient care while ensuring the successful implementation of the new platform and enabling the team to contribute to broader organizational goals without compromising day-to-day operations. Any Additional Upcoming Hiring Needs? None currently |
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| Typical Day in the Role | ||
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Typical day in a role: - Coordinate Home Infusion Nursing utilizing contracted Home Infusion Providers. - Clinical data management and monitoring. - Address home infusion patient needs. - Address nursing agency patient-related concerns. - Take inbound and make outbound calls. - Work collaboratively with other departments and the physician’s office to ensure best patient outcomes. - Manage emails, messages, and trainings daily. - Participate in trainings and meetings as needed. - Manage assigned worklist as well as pended worklist to make patient outreach providing clinical intervention. -Report patient adverse events as necessary. Performance expectations/metrics for this individual and their team: - Must be able to manage daily tasks in a timely manner with a high quality of work. - Goals will be given to the candidate to help them work towards the department’s expectations for success. First day: The candidate will work to set up equipment, meet with manager multiple times throughout the day, and complete assigned trainings. - During onboarding, schedule will be 9:00 am – 5:30 PM CST. |
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| Candidate Requirements | ||
| Education/Certification | Required: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience | Preferred: |
| Licensure | Required: RN - Registered Nurse - State Licensure and/or Compact State Licensure required | Preferred: |
| Years of experience required: 2+ years of clinical nursing experience in a clinical, acute care, community, or home health setting. Home infusion experience with knowledge of home infusion processes, care coordination, and patient education. Disqualifiers: No active RN license in the required state. Less than 2 years of direct clinical nursing experience. Lack of home infusion or care coordination experience. Inability to manage multiple patient cases simultaneously in a fast-paced setting. Additional qualities to look for: Proficient Time Management Skills |
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1 | Proficient Clinical Assessment and Critical Thinking Skills |
| 2 | Proficient Technology Skills (EHR Navigation, Microsoft Office Suite) | |
| 3 | Proficient Time Management Skills | |
| Candidate Review & Selection | ||
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Projected Manager Candidate Review Date: | 1-2 days post shortlisting |
Type of Interviews: |
1 - (Microsoft Teams video interview) | |
| Required Testing or Assessment (by Vendor): | ||
| Next Steps | ||
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Clinical - Care Manager (RN) - J01007 · Mindlance