PALLIATIVE RN CARE MANAGER

Provides telephonic clinical care management services using evidence-based practices to ensure patients receive appropriate, high-quality care that allows them to remain safely in their homes or communities. Reduce inappropriate ER and hospital utilization by increasing access to preventive and primary care.

Provides telephonic clinical care management services using evidence-based practices to ensure patients receive appropriate, high-quality care that allows them to remain safely in their homes or communities.

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Key Responsibilities

• Coordinate and oversee the delivery of benefits and services for assigned members.
• Complete comprehensive care management and disease-specific assessments.
• Make timely telephonic care management calls based on patient risk level.
• Resolve and coordinate complex member issues impacting care delivery.
• Provide health education and coaching to members and caregivers.
• Assess social determinants of health (SDoH) and coordinate care to address barriers.
• Identify member safety issues and connect to appropriate resources (therapy, DME, behavioral health, etc.).
• Ensure high-quality, cost-effective care aligned with evidence-based clinical guidelines.
• Advocate for members and caregivers to obtain needed health services.
• Promote adherence to physician treatment plans through education and support.
• Reduce inappropriate ER and hospital utilization by increasing access to preventive and primary care.
• Participate in interdisciplinary team (IDT) meetings and case discussions.
• Maintain confidentiality of all member information and ensure compliance with federal, state, and payor regulations.

• Must have working knowledge of Medicare and Medicaid programs.