Case Manager

Job Title: RN Case Manager

Reports To: Director, Care Management & Quality Programs

The Case Manager position is responsible for case management, transitions of care, and disease management support. This position has a key role in outreach and monitoring of high cost/risk members as well as providing reinsurance updates to assure proper and timely reporting is completed. This CM role provides significant support to our Account Executive team by helping members with navigation, steering of members to INN providers when possible, coordinating SCA communications and contracting details. The key component of this role include:

• Utilize utilization reports and data analytic tools to identify members for CM outreach.
• Coordinate care across provider and health system relationships.
• Secure the most appropriate level, access, and location for care for member.
• Ensure seamless transitions of care by identifying gaps in services and addressing needs.
• Formulate and document case management plans of care as well as utilize evidence-based practice guidelines to guide care decisions.
• Advocate for members and caregivers as necessary throughout care management plan.
• Teach member/caregiver about health promotion, prevention, and self-management skills.
• Proactively and thoroughly maintain updates on high-risk members for proper internal, reinsurance, and employer group reporting.
• Support Account Executives with employer group reporting and high-cost case identification.

Qualifications

Minimum Skills, Education, Training Requirement:

• RN with minimum of 5 years clinical experience
• Experience in working for or with Health Insurance organizations and understanding of Health Insurance process, terminology, and reinsurance industry strongly preferred.
• Certification in case management preferred.
• Current, unrestricted Indiana RN license
• Sound clinical background
• Analytical skills
• Excellent verbal and written communication skills
• Knowledge of community resources