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Role Description
The Remote Care Manager – RN is responsible for providing telephonic support to patients and their families. Ensures communication and coordination with all stakeholders in the home, community, with payer partners and team members. Proactively manages a census of patients, ensuring quality interactions and follow through resulting in effective clinical outcomes.
• Makes outbound calls designed to build rapport/relationships and catch decline in patient status or acute issue prior to hospitalization or urgent visit need.
• Identifies patients with both chronic and acute needs to ensure their care plans are intact and assists with education, goals of care and ongoing care coordination.
• Identifies hospice eligibility, enters hospice orders and ensures smooth transitions of care.
• Communicates with company medical director about transition to sign the order and notifies the patients primary care physician (PCP).
• Contacts hospice agency to discuss case, verify receipt of order and date/time of visit.
• Follows up with hospice agency daily to verify admission or failed admission.
• Research failed admissions to find out why, notify team members and cancel hospice order if appropriate.
• Performs clinical evaluations and patient education as requested by interdisciplinary team.
• Communicates care plans to other external providers such as PCP, specialists, etc. Requests referrals to specialists.
• Communicates results of tests, lab work, etc. to advanced practice provider who notifies the patient and their family of the results.
• Completes documentation for durable medical equipment (DME) and documentation for Home Health which is sent to medical director for signature.
• Obtains authorizations for medications that are not on the formulary medication list.
Qualifications
• Requires a HS diploma or equivalent and a minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current valid active unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.
Requirements
• Experience in a centralized care management team preferred.
• Prior healthcare experience serving chronically ill patients preferred.
• Health plan, hospice or home health experience preferred.
• Telephonic case management or care coordination experience preferred.
Benefits
• Market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
• Medical, dental, vision, short and long term disability benefits.
• 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources.
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