SCO Nurse Care Manager - Bilingual pref

The Care Manager Nursing (RN CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care, care coordination and navigation, complex case management, population health and wellness interventions, and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical thinking skills, and ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works closely with the member, the caregiver/authorized representative, and providers to meet the targeted member-specific goals. Based on national standards for CM practice, the RN CM focuses on empowering the member to support optimal wellness and improved self-management.
Job Description

Key Responsibilities/Duties what you will be doing

Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment. Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness. Through assessment and collaboration with member/caregiver and providers, develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed. Complete documentation in applicable platform according to departmental policy and regulatory standards.
Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the members care.
Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admission.
Collaborates and liaises with the interdisciplinary care team, to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM). Attending and presenting (as appropriate) high risk members at interdisciplinary rounds forum.
Maintain professional growth and development through self-directed learning activities.
Qualifications what you need to perform the job

Certification and Licensure

Registered Nurse with current unrestricted license in state of residence
May be required to obtain other state licensure in states where Point32Health operates
Understand and follow the provisions of state-specific Nurse Practice Act(s) where Point32Health operates
National certification in Case Management desirable
Education

Required (minimum): Bachelors degree or relevant equivalent experience
Preferred: Bachelors degree in nursing
Experience

Required (minimum): 5 years relevant clinical experience
Preferred: Experience in home care or case management.
Proficiency in a second language desirable.
Experience in specialty areas a plus.
Skill Requirements

Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications
Work cooperatively as a team member across multiple levels within the organization
Skilled in assessment, planning, and managing member care
Advanced communication and interpersonal skills
Independent and autonomous with key job functions
Ability to address multiple complex issues
Flexibility and adaptability to changing healthcare environment
Ability to organize and prioritize work and member needs
Demonstration of strong clinical and critical thinking skills
Regard for confidential data and adherence to corporate compliance policy
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):