Job Title: Remote Registered Nurse

Job Description

The Care Manager plays a pivotal role in providing care management services to beneficiaries, particularly those transitioning from case management or disease management programs. This position is crucial in identifying and addressing fragmented care for patients with acute, real-time needs, tailoring interventions to fill gaps, and ensuring optimal clinical outcomes in a cost-effective manner.

Responsibilities

• Conduct pre-admission counseling by contacting patients with upcoming hospital admissions to discuss expectations.
• Assess the patient's condition to understand illness or injury and evaluate their ability to follow the treatment plan.
• Advise patients on the probable length of stay and assist in anticipating and arranging for services at discharge.
• Collaborate with physicians and hospitals to enforce treatment plans and orders, ensuring patients receive specialty care and tests as ordered.
• Coordinate healthcare team services to avoid duplication and conserve benefit dollars.
• Evaluate the need for and authorize equipment, supplies, and services.
• Identify problems and act proactively to avoid complications.
• Instruct patients and families in proper care, referring them back to physicians or other healthcare team members as needed.
• Conduct hospital visits and confer with physicians to clarify diagnoses, prognoses, therapies, and daily living activities.
• Document case summaries in Transitional Care Plans and share appropriately with beneficiaries and providers.
• Facilitate beneficiary transfers among regions, collaborating with military liaisons to minimize disruption of care or services.
• Coordinate basic benefits and identify modifications, requests for exceptions, or special programs as warranted.
• Assess patient's benefit plan coverage and limitations, negotiating cost-effective rates for provider services.
• Contact patients within 48 hours of discharge to ensure support for full recovery and assess compliance with medications and follow-up appointments.

Essential Skills

• Graduate of a Nursing program, BSN Degree preferred, or graduate in Clinical Psychology or Clinical Social Work.
• Minimum of 2 years of experience.
• Must have and maintain a current, valid, and unrestricted Registered Nurse license.

Additional Skills & Qualifications

• Proficient in computer skills, including Microsoft Suite (Excel, Outlook, Word).
• Experience in case management, Telehealth, telephonic care, acute care, and managed care.
• Strong customer service skills.
• Spanish speaking - Bilingual capability.
• Experience in home health, hospice, and hospital environments.

Work Environment

This is a remote position requiring strong Wi-Fi and a quiet room with a closed door. Work hours are Monday to Friday, between 8AM-7PM EST initially, with the possibility of transitioning to a 4-day workweek after proving competency on contract.