Case Manager – RN, Mid – Part-time (Remote U.S.)

• 4956

Job Description

Company OverviewAcentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is seeking a Case Manager-RN, Mid - Part-time (Remote U.S.) to join our growing team. Job Summary: The Case Manager-RN is responsible for assessing, planning, implementing, monitoring and evaluating options and services to create an appropriate, individualized plan for the member across the continuum of care. Using independent judgment, the case manager utilizes knowledge and competence, communication skills, problem solving and conflict resolution to effectively ensure optimal outcomes with consideration of benefit plan requirements. Also coordinates member behavioral and medical needs related to community resources, financial assistance programs, long-term activities of daily living and other socio-economic needs outside the benefit criteria of the insurance coverage. Will work effectively with all health care team members internally and externally. Responsibilities:

• Manages care of the member through the health care system based on the individual needs of the member.
• Uses independent judgment and discretion to address and proactively resolve barriers impeding the diagnostic or treatment progress.
• Coordinates and collaborates with multidisciplinary care team, which includes physicians, nurses, other case managers, pharmacists, and social workers/educators to ensure holistic management of both behavioral and medical health needs; educates members about community resources/options; advocates on behalf of the member.
• Establishes a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality outcomes.
• Steerage to in network and evidence-based providers/facilities whenever possible for members requesting prior authorization of out of network use.
• Utilization review and/or discharge planning, as needed, when moving from inpatient and/or residential treatment facilities
• Maintains strict standards for client confidentiality and client related information. Complies with all organizational, state and federal regulations and policies on confidentiality.
• Prepares member documentation, status updates, and coordination summaries in accordance with regulatory requirements and company policies and procedures.
• Monitors case load to ensure all required documentation and entry of assessment results into web-based database are completed accurately and timely.
• Pursues ongoing education, certification, and self-development to remain current with case management standards.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The above list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

• * Work Hours for Part-time role (20 hours weekly): Monday–Friday, 8:00 AM to 5:00 PM (Eastern Time Zone) **

Qualifications

Required Qualifications/Experience:

• Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license.
• Associate's degree (or higher level of education) in Nursing.
• 2+ years of clinical experience in an acute OR med-surgical environment.
• 2+ years of clinical work experience in a behavioral health environment.
• 2+ years of case management experience.
• 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization.
• 1+ years of knowledge of medical records, medical terminology, and disease process organization.
• 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG).

Preferred Qualifications/Experience:

• Certified Case Manager (CCM).
• Experience with commercial health plans.
• Ability to multi-task and prioritize with variable and sometimes conflicting deadlines; superior attention to detail and demonstrated ability in decision-making.
• Demonstrated initiative and judgment in performance of job responsibilities, while maintaining professionalism, flexibility and dependability under pressure.
• Strong communication (written/verbal), interpersonal, orga