OnSite-Senior Care Manager (RN)

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On-Site RN Opportunity | Senior Care Manager – Illinois.

Are you a passionate RN with a strong background in case management or utilization management within an inpatient setting? Join our dedicated team at our Illinois Health Plan and make a real difference—right where care happens.

We’re currently hiring a Senior Care Manager (RN) for an on-site hospital-based position in the St. Louis, Missouri area. Candidates must reside in Illinois and within 20 miles of St. Louis MO.

What We’re Looking For:

• Registered Nurse (RN) with active Illinois license

• Experience in case management and/or utilization review

• Previous work in an inpatient hospital environment is preferred

• Strong collaboration and communication skills

Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs

• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services

• Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs

• May identify problems/barriers for care management and appropriate care management interventions for escalated cases

• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations

• Reviews referrals information and intake assessments to develop appropriate care plans/service plans

• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources

• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed

• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner

• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness ​

• Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice​

• Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success

• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness

• Other duties or responsibilities as assigned by people leader to meet business needs

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 – 6 years of related experience.

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact