Care Manager RN - Foster Care

Job Description

Superior HealthPlan is seeking a Care Manager RN for Foster Care to perform care management duties to assess, plan, and coordinate all aspects of medical and supporting services across the continuum of care for select members, in order to promote quality, cost-effective care. The role also involves facilitating member access to community-based services, monitoring referrals, and participating in integrated team care management rounds.

Responsibilities

• Assess the member's current health status, resource utilization, past and present treatment plan and services, and prognosis
• Develop a plan of care based on assessment with specific objectives, goals, and interventions designed to meet member's needs
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff
• Provide patient and provider education
• Monitor referrals made to community-based organizations and medical care
• Identify related risk management quality concerns and report to appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
• Direct care to participating network providers
• Participate in case management committees and work on special projects related to case management as needed
• Coordinate service request/authorizations with UM

Requirements

• Graduate from an Accredited School of Nursing
• Bachelor’s degree in Nursing preferred
• 2+ years of clinical nursing experience and 1+ years of case management experience in a managed care setting
• Knowledge of utilization management principles and healthcare managed care
• Experience with medical decision support tools and government-sponsored managed care programs
• Current state’s RN license

Benefits

• Competitive pay ($66,100.00 - $118,900.00 per year)
• Flexible work solutions including remote options, hybrid work schedules, and dress flexibility
• Paid time off including holidays
• Health insurance coverage for you and your dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development