RN Care Manager

Kids Are Our Everything.   Department 10514 HSCSN - Care Management   Pay Range $77,584.00 - $129,292.80     Under the direction of the Supervisory Care Manager, the RN Care Manager (CM) is responsible for providing comprehensive care coordination services to enrollees with high-complexity medical and behavioral needs who are enrolled in the Health Services for Children with Special Needs (HSCSN) health plan. This CM will have a caseload of medically fragile enrollees focusing on medical intervention and associated care coordination needs outlined by the enrollee assigned acuity level. The CM routinely communicates with enrollees on their assigned caseload to assess their needs; develop, monitor, and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for enrollees with highly complex medical and psychosocial needs.   Minimum Education Associate's Degree in Nursing (Required) Bachelor's Degree in Nursing (Preferred) Minimum Work Experience 2 years Clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or Managed Care (Required) 1 year Working in a Public/community health setting. (Required) Required Skills/Knowledge Must have an advanced knowledge of clinical standards of care and disease processes. Must have excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for enrollees. Spanish Speaking preferred Must be able to provide excellent internal and external customer service. Must be proficient in the knowledge of available community resources and programs and Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint. Must have the ability to produce accurate and comprehensive work products with minimal direction. Must be able to meet established deadlines and handle multiple customer service demands from internal and external stakeholders within set expectations for service excellence. Must have a basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits). Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Facilitates care team meetings, participates in professional, multidisciplinary meetings to include internal and external staff meetings Required Licenses and Certifications Registered Nurse DC License Upon Hire (Required) Certified Case Manager (CCM) 1 Year (Preferred) Job Functions Essential job duties: Manages a caseload as outlined by CASSIP and Care Management Leadership. Maintains compliance in accordance with contractual and care management requirements Assists in research, and…