Care Manager - Population Health RN

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. 2 POSITIONS AVAILABLE POSITIONS WILL WORK EASTERN TIME ZONE HOURS MONDAY-FRIDAY. NO TRAVEL/FULLY REMOTE. Position Purpose: Develops, assesses, and facilitates reputed company care management activities for primarily physical needs members to provide high quality, cost-effective reputed company outcomes including personalized care plans and education for members and their families. Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as reputed company and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Provides ongoing follow up and monitoring of member status, change in condition, and reputed company towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services May reputed company telephonic, digital, home and/or other site reputed company to assess member needs and collaborate with resources Collects, documents, and maintains reputed company member information and care management activities to ensure compliance with reputed company state, federal, and reputed company-party payer regulators Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, reputed company provider instructions, care options, referrals, and reputed company benefits Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner Other duties or responsibilities as assigned by people leader to meet business needs Performs other duties as assigned Complies with reputed company policies and standards ADDITIONAL INFORMATION: Coordinating reputed company for Participants/members with chronic conditions, aiming to improve health outcomes, reduce complications, and enhance quality of life. These positions are focused on the CHC non-dual population. The plan is to support these members with chronic condition management, helping to reduce complications and cost, and increase quality outcomes with care gap closures and HEDIS measures. After successful implementation, goals would be to add more chronic conditions and members based on reputed company. Disease management program will focus on improving the health of members and reducing associated costs from avoidable complications by identifying and treating these chronic conditions more quickly and more effectively, while slowing the progression of the disease. Staff will coordinate care to improve safety and quality of care, improve access to care, improve self-management, improve financial cost containment without sacrificing quality or member satisfaction, and enhance efforts to provide health improvement programs on a population basis. Partnering with multiple departments to ensure shared reputed company, including vendor management, Quality, PHCO, and Finance. Partnering with disease management vendor for coordinated care and services, focusing on specific areas that are not reputed company to be managed by the vendor, i.e. Cancer (Cervical, Breast), Neurocognitive Impairments, IDD, Vent/Trach Dependent, Neuromuscular Disorders, and TBI. Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of reputed company experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $55,100.00 - $99,000.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Thanks for your interest in reputed company and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the reputed company to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email reputed company@reputed company.com. reputed company is committed to helping people live healthier lives. We provide access to high-quality reputed company, innovative programs and a wide range of health solutions that help families and individuals reputed company, stay well and be well. Apply To This Job