Case Management Nurse
EXL
- New York, New York, United States
- New York, New York, United States
Über
Base Pay Range: $36.00 - $43.00 per hour plus bonus
Estimated Travel: Up to 10% for training
Must be a US Citizen
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
Seniority level: Associate
Employment type: Full-time
Job function: Education
Industries: Public Health and Business Consulting and Services
Responsibilities
Conduct a comprehensive assessment with beneficiaries and analyze assessment findings to identify and prioritize clinical, psychosocial, and behavioral concerns and potential gaps in care.
Develop and document a case management care plan in direct collaboration with the beneficiary, the beneficiary's family or significant other(s), the primary physician and other health care providers. Identify and include key concerns, needs, and preferences of the beneficiary and family/caregiver.
Document identified issues, prioritized and individualized goals (long & short term), evidence-based interventions, collaborative approaches and resources, anticipated time frames, and barriers to achieving goals in the care plan.
Coordinate and implement the activities specified in the care plan to provide optimal benefits coverage as well as promote continuity of care and integration of services for the beneficiary across care transitions. Collaborate and communicate with the beneficiary, family, significant other(s), physician, and other health care providers to accomplish the goals on the care plan.
Initiate care conferences with Medical Director and/or the multidisciplinary care team to discuss challenging beneficiary cases and obtain expert clinical opinion or consultation.
Serve as beneficiary advocate by promoting self‑determination, informed and shared decision‑making, autonomy, and self‑advocacy for beneficiaries. Empower beneficiaries by providing education and support to reinforce self‑care management, facilitate access to care, and promote optimal health outcomes.
Identify relevant benefit‑related, educational, and health care resources for beneficiaries. Facilitate coordination of care with existing community‑based programs and services to meet the identified needs of the beneficiary.
Demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient‑centered, culturally sensitive care coordination, and management of complex conditions throughout the case management process.
Collaborate with beneficiaries and their support system/caregivers, providers, the multi‑disciplinary team, and health care and community resources throughout the case management process.
Document appropriate clinical information and data in a timely, accurate, and concise manner consistent with applicable standards of practice.
Qualifications Required
Current, unrestricted RN license in state of residence with multi‑state privileges (an active compact state license)
Must hold United States citizenship status
Ability to obtain Security Clearance required. Current DOD Security Clearance preferred
Associate or bachelor's degree in nursing from an accredited institution. Bachelor’s degree preferred
5+ years of clinical RN experience in direct patient care
Knowledge of case management practices and patient‑centered care concepts
Proficiency in Microsoft Office, mobile technologies and navigating multiple applications
Ability to adapt to changing priorities
Preferred
1+ years of prior case management experience
Case Management Certification highly desirable (CCM preferred)
Experience working in an NCQA accredited case management program
Experience as a telephonic case manager at a health plan highly desirable
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Sprachkenntnisse
- English
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