Clinical Case Manager
 Professional Management Enterprises | |
 United States, Indiana, Indianapolis | |
| 9245 North Meridian Street (Show on map) | |
 Jan 06, 2025 | |
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Job Title: Care Coordinator | Care Manager Location: **Must be an Indiana Resident Hours: Monday - Friday 8am-5pm Job Summary: The Care Coordinator (RN Case Manager) must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). This position is remote, but field visits may be required. Primary Responsibilities: * Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements * Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence * Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care * Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services * Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members * Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team * Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders Required Qualifications: * Resident of Indiana * BSN with equivalent experience * Registered Nurse with an unrestricted License in Indiana * Experience working within the community health setting in a health care role * Experience or knowledge of Indiana Medicaid, Medicare, Long term care * Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment Preferred Qualifications: * 3+ year of case management leadership experience within a healthcare industry * Background in managed care * Case Management experience * Certified Case Manager (CCM) * Experience / exposure with members receiving long term social supports * Experience in utilization review, concurrent review and/or risk management | |