Remote Patient Care Manager (RN) – North Carolina

Overview:
The Care Manager works with adult and pediatric patient members, their support systems, and care team including, but not limited to, providers, health plans, hospitals, community agencies, and organizations to provide evidence-based, integrated, and person-centered complex care management. Care management activities follow the guiding principles as defined by the Case Management Society of America (CMSA) including assessment, plan facilitation, care coordination, evaluation, and advocacy to meet the needs of the member and family. This position is primarily telephonic (75%) but may involve travel to member’s residences and/or provider offices (25%).

Responsibilities:

• Complete comprehensive screenings and assessments to identify current and past medical/behavioral health history, medications, functional abilities, utilization, needs, etc. and provide evidence-based, current education and recommendations for management of condition(s)
• Collaborate with patient member, family, provider, care team, and others to develop, review, and evaluate the member’s plan of care including identified barriers to wellness including physical, mental, psychosocial, behavioral, and social determinants of health (SDOH) needs by providing effective, timely and appropriate care management activities through the development of SMART goals
• Implement a thorough care management process providing holistic care and promoting self-management that results in measurable, improved outcomes including, but not limited to, decreased non-emergent Emergency Department (ED) visits, decreased readmissions, increased medication compliance, improved blood pressure readings, decreased HgbA1C, and more
• Link patient members to appropriate levels of care/appropriate and supportive services, collaborate with relevant community-based services and health care organizations (home health care, school nurses, hospice providers, etc.) to address member needs/barriers to improved health outcomes and to secure necessary care and equipment, address/resolve system problems impeding progress and pro-actively identify and resolve delays and obstacles to expedite care
• Monitor Emergency Department (ED) and hospitalization utilization rates for current and potential active patient members and complete timely follow up outreach, assessments, and education following discharge
• Use Motivational Interviewing (MI) and other communication strategies to engage members and their families in care management initially from provided outreach lists, direct referrals, and during ongoing care management activities
• Consistently maintain minimum established caseload goals
• Practice linguistic and cultural sensitivity in every interaction
• Execute and maintain thorough, timely documentation as required by NCQA and contracting partners
• Adhere to all relevant policies, procedures, and regulations, including HIPAA guidelines

Qualifications:

• RN or LCSW with Licensure in the State of NC
• Care/Case management or relevant health care experience
• Valid NC driver’s license with current auto liability insurance
• Excellent interpersonal, communication, and negotiation skills
• Experience with or ability to learn motivational interviewing skills
• Clinical competence in assigned area
• Strong organizational and time management skills
• Strong computer skills
• Ability to work independently and collaboratively
• Experience delegating to appropriate team members based on scopes of practice and working as part of an interdisciplinary team
• Experience working with individuals with complex medical, behavioral, and social needs throughout the lifespan
• Must reside in Bladen, Brunswick, Columbus, New Hanover, or Pender counties

Preferred Qualifications:

• Certified Care Manager (CCM) certification; required to obtain within 2 years of hire date
• Two or more years providing direct care management services or similar experience
• Familiarity with local community resources

We offer competitive compensation and benefits packages, including health, vision, and dental insurance, retirement plan, and generous paid time off. Join our team of dedicated professionals who are committed to improving health care outcomes in our communities..

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Work setting:

• Remote

Application Question(s):

• Do you reside in either New Hanover, Brunswick, Pender, Columbus or Bladen County?

License/Certification:

• RN or LCSW with Licensure in the state of North Carolina? (Preferred)

Location:

• Wilmington, NC (Required)

Work Location: Remote