Telehealth Case Manager, Nurse

Job Description:

• Conduct comprehensive health assessments of members enrolled in healthcare programs through telephonic and/or digital tool interactions.
• Gather relevant medical, social, and lifestyle information to develop a holistic understanding of each member’s current status.
• Identify potential key risks, gaps in care, and opportunities for enhancing well-being.
• Provide telephonic and/or digital education, nursing interventions, and coaching to members on various health topics, including chronic disease management, preventive care, and healthy lifestyle choices.
• Empower members to take an active role in managing their health by providing them with the knowledge and tools needed.
• Collaborate with members to set achievable health goals and develop personalized action plans.
• Coordinate with healthcare providers and community resources to facilitate access to necessary services and support.
• Facilitate referrals to internal multidisciplinary care team members including Health Management Nurses and Resource Specialists.
• Assist members in navigating the healthcare system, including understanding insurance coverage and finding appropriate providers and resources.
• Regularly monitor individuals' health status and progress towards their health goals through telephonic and/or digital tool check-ins.
• Provide ongoing support, encouragement, and accountability to individuals to help them stay on track with their health management plans.
• Collaborate with healthcare providers to ensure continuity of care and timely interventions when necessary.
• Maintain accurate and up-to-date documentation of telephonic and/or digital tool interactions, assessments, care plans, and outcomes.
• Ensure compliance with privacy and confidentiality regulations, including HIPAA guidelines.
• Ensure adherence to quality benchmarks and standards in all documentation, maintaining accuracy, clarity, and compliance with organizational guidelines.
• Demonstrate timely completion of case management activities in alignment with organizational protocols and NCQA accreditation standards, including documentation, care planning, and follow-up within required timeframes.
• Perform additional duties as assigned based on the evolving needs of the business.

Requirements:

• Registered Nurse (RN) licensure with a minimum of 3 years of clinical experience.
• Aptitude for computer skills, proficiency with Microsoft and web-based applications.
• Experience in health management, care coordination, or telephonic nursing is preferred.
• Strong clinical knowledge and understanding of chronic diseases, preventive care, and health promotion.
• Excellent communication and interpersonal skills, with the ability to engage individuals over the phone and build rapport.
• Demonstrate utmost level of professionalism in all work interactions.
• Empathetic and patient-centered approach to care, with a focus on empowering individuals to take control of their health.
• Ability to understand and explain complex medical information in a clear and understandable manner.
• Strong organizational and time management skills, with the ability to prioritize tasks and manage a caseload effectively.
• Proficiency in using telehealth platforms and digital technology for individualized member monitoring which may include toggling between multiple applications during member calls.
• Ability to handle both inbound and outbound calls providing timely and accurate nursing support and guidance as needed.
• Ability to multitask while working independently and collaboratively in a remote and fast-paced environment.
• Commitment to ongoing professional development and staying updated on the latest healthcare trends and guidelines.
• Case Management or Care Coordination disease management.
• Must obtain CCM Certification within 4 years of employment.
• A Registered Nurse must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states, territories and the District of Columbia based on the needs of the business.
• Education: Associated degree or Diploma in Nursing. Bachelors preferred.
• Preferred: Commission for Case Manager (CCM), Oncology Certified Nurse (OCN).

Benefits:

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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