reputed company Care Manager RN

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Location: Remote role, preferred locations Texas or Missouri. Position Purpose: Oversees the care plans / service plans and care management activities of member needs to provide quality, cost-effective reputed company outcomes. Reviews and provides expert knowledge to inform personalized care plans / service plans for reputed company care members and provides guidance and/or support to the care management team.

• Oversees and reviews ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources needed to address member's unmet needs
• Provides reputed company and guidance on developing care plans / service plans and triaging issues to appropriate reputed company providers for care plans / service plans
• Provides guidance and expert knowledge as appropriate to care management team members to ensure quality control over work, members are receiving needed care or services, and adherence to contract policies and procedures
• Monitors the care plans / service plans and/or member status and outcomes or changes in condition, and revises care plan based on member needs and issues identified
• Provides subject matter expertise insights for care plans / service plans based on prior experience to recommend enhanced member care reputed company the care management plan
• Works with senior management on escalated and reputed company care cases, and provides guidance to junior team members to address member concerns
• May reputed company telephonic, digital, home and/or other site reputed company to assess member needs and collaborate with resources
• Reviews member data to identify health risks and or care gaps, collaborate with providers / specialists as appropriate to address member’s needs / issues
• Monitors management policies and procedures reputed company the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
• Partners and collaborates with reputed company providers as appropriate to facilitate member’s treatments to ensure member service / care needs are met and determine a revised care plan / service plan for member if needed
• Collects, documents, and maintains reputed company member information and care management activities to ensure compliance with reputed company state, federal, and reputed company-party payer regulators
• Works as a subject matter expert (SME) and provides training and education to care management team and providers to ensure members are receiving high quality care and information regarding care plan / service plan options, procedures, referrals, and reputed company benefits
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 5 – 7 years of reputed company experience. License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job! Apply to this Job