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EXL · 6 hours ago

Clinical Case Manager

United States

Full-time

Remote

Mid, Senior Level

$36/hr - $43/hr

5+ years exp

EXL is seeking a caring and driven Registered Nurse to join their team as a Remote Telephonic RN Case Manager. This role involves providing comprehensive case management services for TRICARE beneficiaries with complex or chronic conditions, guiding patients toward improved health and well-being.

AnalyticsBankingOutsourcing

No H1B

Security Clearance Required

U.S. Citizen Only

Hiring Manager

Amy Garten

Responsibilities

Conduct a comprehensive assessment with beneficiaries and analyze assessment findings to identify and prioritize clinical, psychosocial, and behavioral concerns and potential gaps in care

Develop and document a case management care plan in direct collaboration with the beneficiary, the beneficiary's family or significant other(s), the primary physician and other health care providers. Identify and include key concerns, needs, and preferences of the beneficiary and family/caregiver

Document identified issues, prioritized and individualized goals (long & short term), evidence-based interventions, collaborative approaches and resources, anticipated time frames, and barriers to achieving goals in the care plan

Coordinate and implement the activities specified in the care plan to provide optimal benefits coverage as well as promote continuity of care and integration of services for the beneficiary across care transitions. Collaborate and communicate with the beneficiary, family, significant other(s), physician, and other health care providers to accomplish the goals on the care plan

Monitor and continually evaluate the care plan on a scheduled basis to ensure it remains effective and to determine if desired outcomes are met and the goals are achieved. Revise and update the care plan as needed in collaboration with the beneficiary and the health care team

Initiate care conferences with Medical Director and/or the multidisciplinary care team to discuss challenging beneficiary cases and obtain expert clinical opinion or consultation

Serve as beneficiary advocate by promoting self-determination, informed and shared decision-making, autonomy, and self-advocacy for beneficiaries. Empower beneficiaries by providing education and support to reinforce self-care management, facilitate access to care, and promote optimal health outcomes

Identify relevant benefit-related, educational, and health care resources for beneficiaries. Facilitate coordination of care with existing community-based programs and services to meet the identified needs of the beneficiary

Demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient-centered, culturally sensitive care coordination, and management of complex conditions throughout the case management process

Collaborate with beneficiaries and their support system/caregivers, providers, the multi-disciplinary team, and health care and community resources throughout the case management process

Qualification

RN licenseClinical RN experienceCase Management CertificationCase management practicesMicrosoft Office proficiencyTelephonic case managementCultural diversity appreciationCustomer service skillsCommunication skillsCritical thinking skillsOrganizational skills