Network Health WI · 3 weeks ago
RN Care Manager - Condition/Disease Management Focus
Menasha, Wisconsin, United States
Full-time
Hybrid
Mid Level
4+ years expNetwork Health WI is seeking a Registered Nurse Care Manager who will provide member-centric case management services across the healthcare continuum. The role involves assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet the comprehensive health needs of members.
Financial ServicesFitnessHealth CareInsurance
Responsibilities
Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies
Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved
Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff
Evaluate and process member referrals from physicians to other specialty providers
Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met
Works with members and families on self-management approaches using coaching techniques such as motivational interviewing
Educate the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes
Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality
Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning
Stay abreast of current best practices and new developments
Other duties as assigned
Qualification
Required
Graduation from accredited school of nursing
RN licensure in the State of Wisconsin
Four years of clinical health care experience as a RN required
Preferred
Bachelor's degree in Nursing preferred
Case Management certification preferred
Chronic condition management experience preferred, especially: Diabetes, Cardiac, Pulmonology
Previous experience in case management, utilization management, insurance, or managed care preferred
Experience with Medicare, Medicaid preferred
Company
Network Health WI
At Network Health, we do what’s right, even when it isn’t easy. We’re honest and hardworking, just like you, Wisconsin.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Brian Ollech
Chief Financial Officer
Mike Lappin
Chief Legal & Strategy Officer
Company data provided by crunchbase