Complex Case Manager RN - Remote

📋 Description

• • Take full ownership and oversight of a dedicated panel of members, managing individuals with varying health statuses, severities, and complex clinical needs.
• • Conduct comprehensive assessments of the assigned member panel to identify specific health management needs, leveraging data analytics and your professional clinical judgment to determine the most effective clinical interventions.
• • Collaborate with and be supported by a multi-disciplinary team, utilizing your clinical expertise to strategically refer members to appropriate specialized resources and services.
• • Actively manage a caseload of members enrolled in the case management program, engaging in proactive outreach and support.
• • Develop personalized care plans for members, outlining both long-term and short-term goals tailored to their unique health objectives and circumstances.
• • Facilitate behavior change by employing evidence-based techniques and motivational strategies to empower members in their health journeys.
• • Identify and address potential barriers that may impede members' progress towards their health goals, working collaboratively to find solutions.
• • Assist members in coordinating their healthcare services, ensuring seamless transitions and comprehensive care delivery.
• • Connect members with relevant community and healthcare resources to provide additional layers of support and enhance their overall well-being.
• • Continuously monitor, evaluate, and improve the clinical, financial, and functional outcomes for your assigned panel of members, striving for excellence in care delivery.
• • Ensure all case management activities are meticulously documented and conducted in strict adherence to applicable business process requirements, regulatory mandates, and accreditation standards, maintaining the highest levels of compliance.
• • Stay current with and rigorously apply all relevant CMS, state, local, and regulatory agency requirements, as well as applicable standards of practice for case management, including those published by the Case Management Society of America (CMSA) and/or the American Case Management Association (ACMA).
• • Proactively engage in continuous learning to maintain up-to-date knowledge of disease processes, healthcare delivery systems, and emerging best practices in case management.
• • Utilize strong analytical skills to interpret, evaluate, and act upon both clinical and financial data, including the analysis of statistical information to inform care strategies and identify trends.
• • Foster positive working relationships and build consensus among a diverse range of internal and external colleagues, stakeholders, and healthcare providers.
• • Contribute to a high-performing, collaborative team environment, demonstrating flexibility and adaptability in a fast-paced setting.
• • Manage multiple priorities effectively, employing excellent organizational, time management, and project management skills to ensure timely and successful completion of tasks.
• • Operate with a high degree of autonomy and initiative, demonstrating self-direction and the ability to work successfully with indirect supervision.
• • Apply excellent written and verbal communication skills, including presentation and negotiation abilities, to effectively influence others with respect and compassion.
• • Understand the complexities of healthcare costs and the broader healthcare service delivery system to advocate for efficient and effective care.
• • Engage with members from diverse populations, demonstrating cultural competency and sensitivity to their unique needs and backgrounds.
• • Potentially utilize advanced training and experience in therapeutic approaches such as Cognitive Behavioral Therapy (CBT), Motivational Interviewing, or Dialectical Behavior Therapy (DBT) to support member engagement and progress.
• • Contribute to the overall mission of Highmark Health by facilitating optimal health outcomes and enhancing the member experience through expert clinical case management.