RN Case Manager - Remote

ABOUT ADOBE 

Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 committed to positively impacting the lives we touch. The company has a culture of inclusivity and human kindness, based in Phoenix, AZ, with satellite locations in multiple states. APH has been recognized the last two years as one of “America's Fastest-Growing Private Companies” by Inc. 5000 and has earned a "Best Places to Work" award from the Phoenix Business Journal four years in a row.

As one of the country's few fully integrated healthcare providers, APH offers a range of services which include case management, in-home/in-clinic wellness assessments, preventative care, transitional care, and social work services. APH offers customized services for Medicaid, Medicare, and the ACA/Marketplace lines of business.

POSITION PURPOSE 

The RN Case Manager is responsible for assessing patient/family psychosocial needs, planning, implementing, procuring services for, and evaluating care needs. As an RN CM, you’re focused on improving quality of life and health literacy. Coordinates, monitors, and ensures that appropriate and timely primary, acute, and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, and monitors healthcare resources within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for members. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member while collaborating with the treatment team to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the member. 

As an RN CM, you will be expected to work typical business hours, Monday-Friday, 8a-5p. You will have the ability to operate remotely if you reside in one of the following states:

AL, AZ, FL, IL, KY, MN, MO, NE, NC, NM, NV, NY, OR, TN, TX, UT, VA, WA, WI, WV, or WY.

DUTIES & RESPONSIBILITIES

• Evaluates members for case management services and determines the appropriate level of care coordination and management services for member.
• Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate members' need for alternative services.
• Acts as a primary case manager for all assigned SNP members.
• Develops and monitors members' plans including progress toward meeting established goals and self-management activities.
• Interacts with members, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and status.
• Assess the options for care including the use of benefits and community resources to update the care plan.
• Ensures facilitation, collaboration, and coordination with the care team.
• Acts as a resource for staff (i.e., Care navigators and LPN case managers) 
• Act as liaison and member advocate between the member/family, physician, and facilities/agencies.
• Maintains accurate records of case management activities in the EMR using clinical guidelines.
• Coordinates community resources, with emphasis on medical, behavioral, and social services.
• Applies case management standards, maintains HIPAA standards and confidentiality of protected health information, and reports critical incidents and information regarding the quality-of-care issues.
• Ensures compliance with all state and federal regulations as well as corporate guidelines in day-to-day activities.
• Adapts to changes in policies, procedures, new techniques, and additional responsibilities.
• Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds.
• Performs other related duties as assigned by management.

SKILLS & QUALIFICATIONS

• One (1) year of experience in case management is preferred.
• Experience in the care of the elderly in some geographic regions is preferred.
• Experience in home health, physician’s office, or public health is preferred.
• Bilingual (English/Spanish) is preferred.
• Knowledge of HIPAA regulations.

EDUCATION, LICENSES, & CERTIFICATIONS

• Licensed Registered Nurse (RN) is REQUIRED for the state of New Mexico. 
• Must hold an active, current, and unrestricted RN license. This can be obtained either through direct state licensure or a compact license. 
• Nursing Diploma or Associate's is required.  
• Certified Case Manager (CCM) is preferred.
• Current TB Test and CPR will be required for any field events. 
• Bachelor’s degree is preferred. 

BENEFITS & TOTAL REWARDS

• Paid Onboarding and Training 
• Insurance – Medical, Dental, Vision, and Life
• 401k Plan – 3% match
• Employee Assistance Program
• Tuition Reimbursement
• Continued Education Support
• Mileage Reimbursement (if applicable)
• Referral Bonuses
• Paid Holidays (9 days)
• Paid Time Off (15 days)
• Paid Volunteer Hours 

CHARACTER & COMPETENCIES

• Courage – To have the courage to the right thing at the right time.
• Ownership – To take ownership of every issue you touch.
• Respect – To respect yourself, co-workers, and for those whom you care.
• Excellence – To be excellent in all that you do.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Problem-Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

PHYSICAL DEMANDS & WORK ENVIRONMENT

• Occasionally required to stand.
• Occasionally required to walk.
• Continually required to sit.
• Occasionally required to climb, balance, bend, stoop, kneel, or crawl.
• Continually required to talk or hear.
• While performing the duties of this job, the noise level in the work environment is usually moderate.
• May occasionally lift and /or move more than 30 pounds.
• Must be able to physically perform the essential duties of the position which include lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing. 

EQUAL EMPLOYMENT OPPORTUNITY

APH is an Equal Opportunity Employer where all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.