Complex Case Management Nurse

New

Skills

Care Coordination Care Management Clinical Assessment Clinical Experience Communication Skills Discharge Planning Health Navigation NCQA Standards Patient Education Problem Solving

The Complex Case Management Nurse is responsible for coordinating care across various healthcare settings, including inpatient, outpatient, post-acute, emergency room, and home care. The role involves engaging with members facing complex health challenges and developing tailored care plans to meet their needs.

Key Responsibilities
  • Coordinate care across multiple settings: inpatient, outpatient, post-acute, ER, and home care.
  • Engage with members to address complex health challenges and create individualized care plans.
  • Collaborate with hospital case managers on discharge planning.
  • Provide education to members via phone or secure messaging regarding their conditions, medications, and procedures.
  • Ensure compliance with CCM NCQA standards in daily practices and workflows.
  • Adhere to all applicable laws and regulations.
  • Perform other duties as assigned.
Required Skills & Qualifications
  • Active unrestricted RN license in the US (state) or compact multi-state license.
  • Ability to obtain additional state licenses as required.
  • Minimum of 2 years of clinical experience in payer, hospital, outpatient, or community care management.
  • At least 1 year of experience in care coordination and navigation.
  • CCM Certification is required.
  • Knowledge of NCQA accreditation standards and experience.

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Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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