- Specialty: Case Management
- Job type: Full-time
- Salary: Salary not listed
- License states: District of Columbia, Maryland, Virginia
- Hybrid
Hybrid
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At a glance
Remote telephonic RN case management for a Medicare Advantage Special Needs Plan at Alignment Health. Coordinates care, completes assessments, and closes gaps in care for members with complex chronic needs. Requires an active California RN license (non-compact) plus willingness to obtain licensure in NV, AZ, NC, and TX
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Remote RN Case Manager SNP (must have RN License in California [Non-Compact]) is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. Delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. Assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. Reaches out and connects with members via the telephone.
Schedule: Must be willing to work 8:00am - 5:00pm Pacific Time
GENERAL DUTIES / RESPONSIBILITIES
1. Coordinates care by serving as a resource for the member, their family, and their physician. 2. Ensures access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate. 3. Completes comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan, and services. 4. Collaborates with the member, the PCP, and other members of the care team to implement a plan of care. 5. Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans. 6. Provides education and self-management support based on the member’s unique learning style. 7. Assists in problem solving with providers, claims or service issues. 8. Works closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination. 9. Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
N/A
• Preferred: Health Plan experience preferred
• Required: Successfully passing Post High School courses to obtain an RN licensure or AS in Nursing.
• Preferred: BSN or Bachelor's
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Pay Range: $77,905.00 - $116,858.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
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