Description:

Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

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 progress 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 perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare 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 all policies and standards

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

•\tOutreaching member to enroll them in CM program

•\tBuilding care plans, medication review, assessments care plans

Describe the performance expectations/metrics for this individual and their team:

•\t20 calls/day

Tell me about what their first day looks like:

•\tSystem-specific training

What previous job titles or work will be in this role?

•\tCase Management that has remote experience

•\tHome Health Care/Hospice, but not their only experience

M-F Day Shift Fully REMOTE

Additional Skills & Qualifications:

Education/Experience:

Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.

License/Certification:

RN - Registered Nurse - State Licensure and/or Compact State Licensure required Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.