Job Summary

The Telephonic RN Care Manager manages high-risk, chronic illness members to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and financial outcomes. The Telephonic RN Care Manager will formulate and implement a care management plan that addresses the member's identified needs by assessing issues, resources, and care goals. The Telephonic RN Care Manager will advocate for the member and support the member in navigating the health care system. Additionally, the Telephonic RN Care Manager will collaborate with the interdisciplinary team and members PCP / Health Care Team to identify and support achieving the member's short-term and long-term health goals. HTA’s Care Management model is to provide longitudinal care management for identified members. A vital goal of the Telephonic RN Care Manager within the longitudinal care management framework is to manage the post-acute care of identified members to avoid and limit poor health outcomes, frequent emergency room visits, and hospital readmissions. Based on the RN’s work experience in nursing and knowledge of the health care system, the aims are to provide members with education and resources to reduce preventable emergency room visits, hospitalizations, and readmissions. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

This position must be able to:

• Collaborates with providers and practice staff in identifying appropriate members for care management, utilizing established Care Management criteria.
• Performs initial and periodic holistic assessments for identified care-managed populations. This includes physical and psychosocial concerns for members as appropriate. The assessment consists of a systematic and pertinent data collection about the member's health status. Prioritizes members according to intensity, need, and required follow-up.
• Formulates and implements a care management plan that addresses the member’s identified needs by assessing the member/family needs, issues, resources, and care goals; determining the choices available to individual members; and educating the patient/family on the choices available to meet their goals.
• Establishes a care management plan mutually agreed upon by the health care team and the member/representative. Plans specific mutual self-management goals, objectives, and action-oriented interventions with the members.
• Evaluate the effectiveness of the care plan in meeting established care goals; revise the plan as needed to reflect changing needs, issues, and goals. Monitor and evaluate the member's progress at prescribed minimal intervals.
• Collaborates with the healthcare team to revise the care management plan when changes occur. Initiates/participates in care conferences to discuss multidisciplinary team responsibilities, member progress, new problems, etc.
• Identifies and effectively utilizes community resources to meet the SDOH needs of members/families. Facilitates member access to community resources as appropriate in collaboration with Social Work.
• Promotes member self-management and empowers members/families to achieve maximum wellness and independence. Interacts professionally with members/families and involves them in the formation of a plan of care.
• Performs transitional follow-up calls for members recently discharged from acute hospitalizations, with particular emphasis on those members who are at high risk for readmission.
• Collaborates with providers and other healthcare team members, including inpatient facilities, outpatient providers, and the Utilization Management department, to initiate transitions of care and facilitate care across the healthcare continuum, and optimize clinical and financial outcomes.
• Determines and completes appropriate referrals to internal and external associates. Serves as a liaison to providers, members, and families to coordinate services.
• Maintains accurate and timely documentation. Ensures documentation meets current standards and policies.
• Strives to meet established standards for productivity.
• Participates in regular team meetings and peer review activities. Participates in departmental and organizational committees, as applicable. Assists/supports in the orientation of new personnel. Promotes collaborative teamwork.
• Meets with the care management team regularly to provide member updates, identify issues, and develop strategies for resolution.
• Performs all duties and responsibilities according to the Nurse Practice Act and the basic principles and guidelines of professional nursing.
• Maintains appropriate professional boundaries with members, families, coworkers, and community providers.
• Maintains a working knowledge of and adheres to applicable federal and state regulations, including, but not limited to, laws related to patient confidentiality, release of information, and HIPAA.
• Interacts harmoniously and effectively with others, focusing on attaining organizational goals and objectives through teamwork.
• Conforms to acceptable attendance and punctuality standards in the HTA Employee Handbook.
• Abides by the organization’s compliance program and requirements. Current on all required training for the current year. 

Education and Experience

Education:

• Associate Degree in Nursing

Required Experience:

• Five years combined of nursing-related care experience and/ or home care experience.
• Candidate needs to be local and be able to travel to local facilities as needed for this position.

Preferred Experience:

• BSN or Advanced Degree in Nursing
• Case Management Certification desirable.
• Case Management, Care Management, Telephonic Case Management, and/or Disease Management experience

Other Requirements:

• Registered Nurse licensed in North Carolina or a Compact state.
• Current NC RN licensure in good standing
• Valid NC driver’s license
• Annual Flu Vaccine

Knowledge, Skills and Abilities:

Required Competencies: 

• Knowledge of care management concepts along the continuum
• Knowledge of Medicare benefits
• Experience and ability to use Microsoft Office products and word-processing software daily.
• Must be able to drive to local healthcare facilities to meet with members/providers as needed.
• Excellent written, verbal, and listening communication abilities. Communicate appropriately and clearly to members, coworkers, and        providers.
• Ability to manage conflict, stress, and multiple simultaneous work demands effectively and professionally.
• Ability to successfully articulate the process of attaining goals and outcomes of care management.
• Ability to apply clinical knowledge and experience in a care management role.
• Ability to engage and collaborate with the member and significant others in the care management process.
• Ability to care manage diverse populations without applying one’s values.
• Ability to work with minimal supervision within the nursing scope of practice.
• Ability to think critically and analytically and work with minimal supervision.
• Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development.
• Ability to use good judgment to protect personal safety while performing duties.     

Physical Requirements:

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or a negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods.
• Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

ABOUT HEALTHTEAM ADVANTAGE

HealthTeam Advantage is an equal-opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

HealthTeam Advantage (HTA), a Greensboro-based health insurance company, offers Medicare Advantage plans to eligible Medicare beneficiaries in 33 North Carolina counties. HTA has been named a “Best Places to Work” finalist three times by Triad Business Journal. To learn more, visit HealthTeamAdvantage.com