Nurse Case Manager - RN (Remote U.S.)

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Nurse Case Manager – RN (Remote U.S.) to join our growing team.

** Contractually Required Work Hours:  Monday - Friday 8:00 AM to 5:00 PM Pacific. **

** This is a full-time, direct hire, exempt (salary), remote-based opportunity with Benefits. **

Job Summary:

The Nurse Case Manager – RN:

• Utilizes clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards.
• Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

Job Responsibilities:

• Contacts and performs initial interviews with patients who need health coaching programs.
• Provides necessary coaching to reduce or eliminate behaviors that are considered high-risk.
• Identifies the required goals that each patient must fulfill and advises of feasible options for achieving the goals.
• Educates members on health issues/concerns and the way in which one could combat them.
• Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete a self-management goal/action plan.
• Maintains current knowledge regarding CHF, HTN, COPD, asthma, and diabetes, as well as related treatments and complex medications.
• Performs ongoing reassessment of the review process to offer opportunities for improvement and/or change.
• Conducts clinic one-on-one visits with Disease Management Chronic Care Program participants, utilizing the Chronic Care Model, to assess patient needs for DME, home health, value-added services, and any other necessary resources.
• Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Always maintains medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines.
• Actively cross-trains to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.

The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Requirements

Required Qualifications/Experience:

• Active unrestricted RN Oregon State clinical license per contract requirements.
• Graduation from an accredited Bachelor’s Degree Nursing Program.
• 1+ years of clinical experience in an acute or med-surgical environment.
• 1+ years of case management and/or disease management experience.
• Medical record abstracting skills.
• Knowledge of the organization of medical records, medical terminology, and disease process.
• Excellent communication, problem-solving, and decision-making skills.
• Ability to effectively manage and prioritize tasks.
• Ability to work in a team environment.
• Flexibility and strong organizational skills.
• Must be proficient in Microsoft Office and Internet/web navigation.

Preferred Qualifications/Experience: 

• Case Management Certification (CCM).
• Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) standards.
• Utilization Review (UR) and/or Prior Authorization or related experience.
• Knowledge of InterQual criteria.
• Familiarity with ancillary services, including HHC, SNF, Hospice, etc.
• Experience in managing complex or catastrophic health