Case Management RN Lead

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 RN Lead to join our growing team.

Job Summary:

The Case Manager, RN Lead, will support and contribute to enhancing the company’s success through support of the case management function, acing a first level touchpoint for case manager questions, issues, system discrepancies, and escalations. The goal is to support personalized care planning, member outreach, caseload management, compliance and optimized outcomes.  outcomes and compliance with payer standards. This will require collaboration with healthcare team members to strengthen the overall effectiveness of care delivery, while their expertise in coordinating diverse beneficiary needs and contract deliverables. This role will continue to work as a case manager with a case load, but will be mentored to support individual team mates. 

*Position is remote within the United States. Candidates in Oregon are preferred.  

Job Responsibilities: 

• Resolve issues and escalations specific to case manager concerns with members and community interactions, recognizing when to involve manager or other leadership versus immediate resolution
• Ability to quickly recognize and categorize issues for resolution and appropriate next steps
• Become expert in OARs governing contract and case management services in the state of OR
• Comprehensive understanding of the case management program standards, deliverables, goals, and outcomes
• Ability to assist in system issues or barriers during outages or other service disruptions
• Ability to mentor colleagues and lead by example for optimized individual and team performance
• Backup for Supervisor or Manager for operational functions that do not involve direct employee supervision or management
• In addition to all of the case manager requirements below, the above requirements are key for this Lead role.
• Provide care coordination/care management for beneficiaries, ensuring a high level of clinical knowledge and performance by the clinical team. 
• Foster a caring philosophy in leadership and all aspects of the care management process.
• Manage the care of beneficiaries through the healthcare system based on their individual needs.
• Use independent judgment and discretion to address and proactively resolve barriers impeding diagnostic or treatment progress.
• Interact and collaborate with a multidisciplinary care team, including physicians, nurses, case managers, pharmacists, and social workers/educators to ensure beneficiary needs and preferences for health services/information are shared. 
• Educate beneficiaries about community resources/options and advocate on behalf of the beneficiary.
• Establish a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality outcomes.
• Maintain open communication with all appropriate parties.
• Maintain strict standards for client confidentiality and client-related information. Comply with all organizational, state, and federal regulations and policies on confidentiality.
• Prepare documentation, status updates, event notifications, and other documentation regardingbeneficiaries in accordance with regulatory requirements and company policies and procedures.
• Monitor case load to ensure all required documentation and entry of assessment results into a web-based database are completed accurately and promptly.
• Pursue ongoing education, certification, and self-development to remain current with case management standards and pursue CCM certification.
• Other duties as assigned.

Requirements

Required Qualifications/Experience:

• Bachelors of Science in Nursing.
• 3+ years clinical experience.
• Oregon RN License.

Preferred Qua