Role Overview: The Complex Care Manager, RN is responsible for managing high-risk members to promote their independence and self-sufficiency. They conduct assessments, develop and revise care plans, and coordinate services in community or home settings, focusing on disease management and health maintenance. The role involves telephonic and face-to-face engagement, advocating for members, collaborating with healthcare providers, and ensuring proper documentation.
Key Responsibilities:
- Engage members and families to coordinate services and treatment needs
- Deliver holistic, person-centered care based on individual needs
- Identify early risk factors and conduct ongoing health assessments
- Develop, review, and update comprehensive care plans
- Act as an advocate for members and coordinate with PCPs and community resources
- Build relationships and assist members with health decisions
- Ensure timely documentation and coordinate with state agencies and providers
- Serve as the primary contact for members and care teams
Qualifications & Skills:
- Unrestricted RN license in Virginia
- 2+ years in case management, home or long-term care, or related settings
- 1+ years working with individuals with complex medical or behavioral needs
- Proficiency in Microsoft Office and reliable internet
- Ability to travel within Virginia and access to transportation
Preferred Qualifications:
- CCM certification
- Experience with Medicare/Medicaid and managed care
- Experience with complex populations