Care Manager, Telephonic Nurse

Overview

Become a part of our caring community and help us put health first

The Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Telephonic Nurse Case Manager will collect and document data to facilitate measurement of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary;

organize, arrange and coordinate services necessary to address the beneficiary’s condition. In their role, the Case Manager will collaborate with other care management programs until the beneficiary’s needs are met, and case closure or graduation is achieved. Performs all duties within the scope of his/her licensure.

KEY ACCOUNTABILITIES

• 35% Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources (SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care.
  
  Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
• 30% Utilize applicable sources of information to identify, assess, and enroll patients requiring case management.
• 25% Coordinate and collaborate with other members of the care management team or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management team.
• 10% Support the Care Coordinators with the coordination of care for beneficiaries not under case management as needed.

Use your skills to make an impact

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position.
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS).
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• Bachelor's degree in Nurse (BSN).
• Valid and unrestricted Registered Nurse (RN) license in the (appropriate state) with no disciplinary action.
• An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, you must be able to obtain a CCM within the first year of hire.
• Three (3) or more years of clinical acute care experience.
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.

Preferred Qualifications

• 2 or more years of experience with case management, discharge planning and patient education for adult acute care.
• Experience with TRICARE policies and/or the military health care delivery system.
• Knowledge of MCG or Interqual.
• Managed care experience.

Additional Information

Work Days/Hours :
Monday – Sunday; must be able to work an 8-hour shift sometime between the hours of 8:00 a.m. – 6 p.m. in your reflective time zone, 40 hours a week plus additional hours for potential overtime and rotating hours for weekends/holidays.

Training/Training Hours :
Mandatory for the first 4 – 6 weeks; 8:00 a.m. – 5:00 p.m. Eastern Standard Time.

Work Style :
Remote

Work at Home/Remote Requirements

To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of…