Case Management Triage Nurse - 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 Case Management Triage Nurse – RN (Remote U.S.) to join our growing team.

Job Summary:

The Case Management Triage Nurse – RN is responsible for:

• Outreach to health plan members to assess and determine if they have intervenable needs that can be addressed through Case Management, Disease Management, Health Coaching, Care Navigation, or Care Coordination.  
• Using independent judgment, knowledge, expertise, and excellent communication skills to assess the members’ needs and engage them in enrollment into the appropriate program to meet their needs.  
• Working collaboratively with all healthcare team members, internally and externally. 

** Work Hours: Monday-Friday, 8:00 AM - 5:00 PM in the Eastern OR Central Time Zones. **

Job Responsibilities:

• Utilizes predictive modeling and risk tool reports to determine the priority of outreach to members based on risk score, claims history, medications, and referral task reason(s).
• Opens case in electronic medical record system, creates a triage program, and begins member outreach.
• Using motivational interviewing, complete a screening assessment to identify intervenable needs.
• Review needs with a member, discuss how the program can help meet their needs, and get their consent to enroll. 
• Assign members who consent to the applicable program; provide members with the name of their assigned case manager and generate a welcome packet.
• Assign a "new case" task to the applicable case manager.
• Provide short-term interventions for members who declined CM program enrollment but have immediate needs.
• Complete screening assessment outcomes and document any interventions discussed with members.
• Educates members about community resources/options, if needed.
• Maintains strict standards for client confidentiality and client-related information.  Complies with all organizational, state, and federal regulations and policies on confidentiality.
• Prepares member documentation and coordination summaries in accordance with regulatory requirements and company policies and procedures.
• Pursues ongoing education, certification, and self-development to remain current with case management standards and licensure requirements.

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:

• Current, unrestricted RN compact license.
• Associate's Degree in Nursing.
• 3+ years of clinical experience performing case management services in a medical or behavioral health environment.

• Ability to multitask and prioritize with variable and sometimes conflicting deadlines; superior attention to detail and demonstrated ability in decision-making.
• Demonstrated initiative and judgment in performing job responsibilities while maintaining professionalism, flexibility, and dependability under pressure.
• Strong communication (written/verbal), interpersonal, organizational, and time management skills with a strong focus on customer service, including building and maintaining relationships with internal/external customers.
• Ability to work independently and as part of a team.
• Ability to research/identify and apply appropriate standards of care.
• Interest in continuous learning and a commitment to staying informed on regulatory changes.
• Motivational interviewing skills and ability to positively motivate members to participate in programs during outreach.
• Proven track record of excellent engagement skills in case management programs.
• Experience in triaging and prioritizing cases based on risk and identified needs.
• Strong clinical acumen and ability to identify issues that may warrant enrollment in a case management program.
• Abil