PA Hybrid RN Case Manager

As a Hybrid RN Case Manager, you'll engage with members through face-to-face interactions in community settings or over the phone to conduct comprehensive assessments and collaboratively develop care plans. You'll use motivational interviewing, active listening, and problem-solving skills to support members in achieving their healthcare goals. Your responsibilities include identifying urgent situations, educating members on health and wellness, and connecting them with relevant community resources. This position requires excellent documentation and technical skills to navigate various computer applications.

Primary Responsibilities:

• Engage with members in community settings or over the phone.
  
• Conduct comprehensive member assessments, including bio-psychosocial, functional, and behavioral health needs.
  
• Use motivational interviewing to help members identify and achieve their intrinsic goals.
  
• Employ active listening to gather and retain member information during assessments.
  
• Collaboratively develop individualized care plans with members.
  
• Identify and escalate urgent member situations as necessary.
  
• Assist members in setting healthcare goals and overcoming barriers to achieving these goals.
  
• Educate members on health and wellness to aid in self-management.
  
• Connect members with relevant community resources.
  
• Present complex cases to an interdisciplinary care team for input and guidance.
  
• Use computer applications (e.g., Excel, Word, Outlook) to summarize and communicate member information.
  
• Document assessments, interactions, referrals, and follow-up plans in relevant systems.
  
• Stay updated on changes to computer systems and apply this knowledge effectively.
  
• Achieve performance goals within a virtual environment.
  

Required Qualifications:

• Must reside in the Philadelphia, PA region.
  
• Bachelor’s degree or an Associate degree with an RN license.
  
• Unrestricted license as a Registered Nurse in the state of PA.
  
• 4+ years of experience in Case Management and/or Care Coordination.
  
• Experience managing populations with complex medical or behavioral health needs.
  
• Proficient in Microsoft products, including Excel and Outlook; quick learner of clinical applications.
  
• Designated workspace and secure high-speed internet via cable/DSL at home.
  
• Current driver’s license, auto insurance, and ability to travel for occasional field visits.
  
• Strong passion for helping members with complex needs.
  

Preferred Qualifications:

• Background in Managed Care.
  
• Certified Case Manager (CCM) certification.
  
• Bilingual capabilities a plus.
  
• Experience in utilization review, concurrent review, and/or risk management.