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Registered Nurse - Case Managment Certification
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Registered Nurse - Case Managment Certification

Job Description

ALEGIS CARE, a division of Cigna HealthSpring, is the premier multi-speciality practice that is 100% focused on providing exceptional medical care to patients in homes and facilities.

We are seeking a certified case manager for our busy and growing chronic care team!

RN - Certified Case Manager for internal chronic care team

Role: RN / BSN ( must be certified in case management or willing to get certified within 6 - 12 months )
Location: Chicago, IL

Report to: Chief Operations Officer & Chronic Care Management Director

Full-time days - Mon - Fri.
Benefits: Full corporate benefits package
PTO : 18 days



OBJECTIVE

RN Case Manager will join a team of associates who will provide guidance to our members regarding their health care needs as part of our Chronic Care Management and Skilled Nursing Facility Management Programs

OVERVIEW

As a clinical front line leader for our ALEGIS CARE Chronic Care Management (CCM) and Skilled Nursing Facility(SNF) Programs,you will be responsible for coordinating clinical and non clinical care for our patients.  This will be performed in conjunction with other health care providers inside and outside of the organization.  You will be responsible for the review of both actual and proposed medical care and services against established clinical protocols and program guidelines.

SPECIFIC DUTIES TO INCLUDE

  • Monitor calls.
  • Track performance.
  • Report trends.
  • Conduct CCM and SNF program analysis and make recommendations for improvement.
  • Implement appropriate actions to control trend.
  • Create and conducts provider outreach initiatives.
  • Ensure compliance with regulatory requirements.
  • Recommend services for Health Plan members utilizing care alternatives available within the community and nationally.
  • Recommend alternatives if appropriate using your knowledge of clinical protocols.
  • Identify members for specific case management and / or disease management activities.
  • Taking after hours call to be available for patients and assist providers.
  • Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.
  • Ability to interact with a member in their living environment.
  • Proactively screen patients for changes in their medical status.
  • Develop non hospital alternatives of assistance to patients
  • Proactively address end of life wishes and expectations with patients and family members.
  • Other duties as assigned

 

KEY COMPETENCIES

Leveraging Technology:

You are technological savvy and need to be able to appropriately share and use your knowledge to improve business results with Alegis Care and the Health Plan.  This includes being user savvy with the Microsoft Office package and our Electronical Medical Record.

Problem Solving:

You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving to achieve stated program goals.

Accountability:

You meet clearly stated expectations and take responsibility for quality patient care and achieving program results.

Clinical Knowledge:

 You understand clinical program design, implementation, management and monitoring to support choice within your chosen network. Understands medical utilization implications of the program.
Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.
 

REQUIREMENTS:

  • Current RN license in the state of IL  -
  • Ability to be licensed in multiple states without restrictions.
  • Case Management Certification
  • Minimum of 5 years of clinical experience, preferably managing complex, higher risk patients        
  • Progressive clinical experience preferably in an acute care, skilled or rehabilitation
    clinical setting.
  • Ability to work independently under general instructions and with a team
  • Valid driver’s license
  • Multi-tasking ability
  • Professionalism

 

Job Requirements

ADDITIONAL ROLE DESIRABLES:

  • Bachelors degree in nursing or beyond ( RN, MSN or NP )
  • Health Plan experience
  • Prior Medicare / Medicaid experience
  • Call center or triage experience helpful
  • May substitute equivalent education and/or experience for degree
  • Previous experience in utilization management, discharge planning and/or
    home health or rehab

 

Job Snapshot

Employment Type Full-Time
Job Type Nurse, Health Care
Education 4 Year Degree
Experience At least 4 year(s)
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
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Registered Nurse - Case Managment Certification


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