RN Care Manager​/Disease Management Focus

RN Care Manager – Condition/Disease Management Focus

The Registered Nurse Care Manager provides case management services that are member‑centric and include assessment, planning, facilitation, care coordination, evaluation, and advocacy for all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost‑effective outcomes.

Location:

Candidates must reside in the state of Wisconsin. This position is eligible to work from home (reliable internet is required). Travel to the corporate office in Menasha is required occasionally, including on the first day.

Hours:

1.0 FTE, 40 hours per week, 8am‑5pm Monday through Friday.

• Screen candidates for case management and complete assessments, care plans with prioritized goals, interventions, and time frames for reassessment using evidence‑based clinical guidelines.
• Review results from medical or behavioral tests and procedures and update the care plan to reflect progress toward goals; close cases when expected goals/outcomes are achieved.
• Provide information and outreach regarding case or condition management activities to members, caregivers, providers, and their administrative staff.
• Evaluate and process member referrals from physicians to other specialty providers.
• Assess, plan, facilitate, and advocate for individuals to identify quality, cost‑effective interventions and services that meet health needs.
• Work with members and families on self‑management approaches using coaching techniques such as motivational interviewing.
• Educate the individual, their family, and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources, and insurance benefits to support quality, cost‑effective health outcomes.
• Facilitate the coordination, communication, and collaboration of the individual’s care among providers, including tertiary, non‑plan providers, and community resources, with the goal of controlling costs and improving quality.
• Schedule visits with the individual and participate in facility‑based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
• Stay abreast of current best practices and new developments.
• Other duties as assigned.

• Graduation from an accredited school of nursing.
• Bachelor’s degree in Nursing preferred.
• RN licensure in the state of Wisconsin.
• Case Management certification preferred.
• Four years of clinical healthcare experience as an RN required.
• Chronic condition management experience preferred, especially:
• Diabetes
• Cardiac
• Pulmonology
• Previous experience in case management, utilization management, insurance, or managed care preferred.
• Experience with Medicare and Medicaid preferred.

• Seniority level:
  Mid‑Senior level
• Employment type:
  
  Full‑time
• Job function:
  Health Care Provider
• Industries:
  Insurance

Network Health is an Equal Opportunity Employer.