Case Manager RN (49541)

WHO WE ARE: GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning. WHO YOU ARE: This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care. ESSENTIAL JOB FUNCTIONS: Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures. Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes. Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges. Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention. Coordination of services for members, including community resources and collaboration with other members of the care team. Educate members and their caregivers on conditions and self-management techniques. Initiate and participate in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT. Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.