Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes. Evaluate the needs of the member, barriers to accessing appropriate care, and social determinants of health needs, focusing on member-identified priorities.
Numbers & Facts
Location
Various, KS
Salary
$48.40 Per Hour
Description
Summary:
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes.
Includes personalized care plans and education for members and their families.
Responsibilities:
Evaluate the needs of the member, barriers to accessing appropriate care, and social determinants of health needs, focusing on member-identified priorities.
Develop ongoing care plans and collaborate with providers to identify resources to address unmet needs.
Identify problems/barriers to care and provide appropriate care management interventions.
Coordinate between the member, family/caregivers, and care provider team to ensure adequate and appropriate person-centered care.
Provide ongoing follow-up and monitoring of member status, condition changes, and progress towards care plan goals.
Provide resource support for local services (e.g., employment, housing, independent living) based on assessment and plans.
Facilitate care management and collaborate with providers or specialists to ensure timely access to needed care.
Perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
Collect, document, and maintain member information and care management activities to ensure compliance with regulations.
Provide education to members and their families/caregivers on disease processes, resolving care gaps, and healthcare benefits.
Provide feedback to leadership on opportunities to improve care and quality delivery for members in a cost-effective manner.
Comply with all policies and standards.
Requirements:
Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing.
Minimum 2 years of related experience.
RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
Preferred Skills:
For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL.
For Sunshine Health (FL) Only: Minimum of two years of pediatric experience. May require up to 80% local travel.