Bilingual (English/Spanish) Transitions of Care RN Case Manager

$85,000 - $100,000 / year

Job Description

A bit about this role:
We want to help patients navigate the healthcare system in a better and safer way, and case management is critical to achieving this for our most vulnerable and complex patients. You'll be responsible for providing telephonic, short-term, interdisciplinary care management in the 30 days post-discharge for patients at high risk for readmission. You'll serve as an advocate for these patients, coordinating care and ensuring they have the necessary resources and support to achieve better health outcomes.

Our ideal RN is caring, compassionate, solution-oriented and enthusiastic about providing an outstanding experience for Devoted Health’s patients. They are committed to integrity, excellence, and empowering our patients to confidently navigate the healthcare system and live healthier lives. They are ready to innovate, adaptable to a continuously evolving startup environment, working with the whole Devoted family to create a revolution in how care is delivered.

Your Responsibilities and Impact will include:

Working with patients

Engaging with our newly discharged patients telephonically to understand their needs, supported by technology and data tools.
Conducting assessments to identify comorbid conditions, ED/hospitalization history, medications, psychosocial factors, and patient values and preferences.
Developing care plans in partnership with patients and their caregivers - problems, goals, interventions - while continuously evaluating the patient’s progress.
Explaining complicated medical terms in plain language.
Educating patients on their chronic conditions including teaching “red flags,” developing plans during an exacerbation, and identifying barriers to important care elements such as medication adherence.
Hearing the red flags and providing active care management to close the gaps.

Working with other providers and resources

Partnering with the TOC Nurse Practitioners and Physicians to ensure smooth handoffs, comprehensive follow-up, and coordinated care during the post-discharge period.
Referring patients to Devoted Medical when applicable and working closely on partnering for patient care.
Working closely with Devoted Community Guides (locally-based social workers) to identify community-based organizations to support our patients in meeting their goals.
Coordinating post-treatment care and DME needs.
Collaborating closely with our PCP partners, to coordinate care and deliver evidence based, effective, and accessible health care.

Required skills and experience:

An unrestricted Compact RN license obtained in the United States with the ability to secure other licensure states
3-4 Years of Experience of RN Care Management/telephonic case management experience
Fully bilingual in English/Spanish
Working hours are Monday-Friday 10am-6:30pm ET or 10:30am-7:00pm ET. We are looking for candidates who are located in CT/MT/PT time zones.

Desired skills and experience:

Enthusiasm for working in a setting where meaningful time is spent on the phone with patients and/or their caregivers to build trust, educate, and coordinate care
Comfort and confidence working in an environment guided by performance and productivity metrics, with a focus on quality outcomes and patient experience
Health insurance experience, particularly Medicare Advantage
Prior Special Needs Plan, Population Health, or Transitions of Care case/care management experience
Clinical analytical thinking that allows you to apply your skills to the individual needs of each patient
Telephonic care/case management experience

Salary Range: $85,000 - $100,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Share this job

Related Jobs

Telehealth

Full-time

1 day ago

Clinical Quality Specialist, RN - Michigan

McLaren Health Care Flint, MI

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Clinical Quality Specialist RN, to join in leading the organization forward. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org Position Summary: The Clinical Quality Specialist RN is responsible for clinical elements of the PQI process for the Plan, participating in the HEDIS process, participating in NCQA activities, as well as implementing quality interventions and conducting evaluation to ensure on-going feedback and program effectiveness. Essential Functions and Responsibilities: Provides clinical knowledge (i.e. clinical standards of care, best practices) and support for Potential Quality Issues (PQI) for all lines of business for the Plan. Investigates and responds timely to Potential Quality Issues (PQIs). Participates in the annual HEDIS process. Serves as subject matter expert on the certified HEDIS software system for support of the HEDIS process and other quality projects/reporting. Works with manager in developing and promoting HEDIS initiatives, participating in applicable Quality Committees, and work groups as needed or required. Serves a clinical reviewer of all quality documents. Required: Associate degree in nursing or related field. Current valid RN License in state doing business in. Five (5) years’ clinical or managed care health plan experience with at least two (2) years’ demonstrated experience in clinical quality improvement processes, including HEDIS and NCQA. Preferred: Bachelor’s degree in nursing or related field. Project management experience. CPHQ. Healthcare data management and analysis experience. Additional Information Schedule: Full-time Requisition ID: 26003085 Daily Work Times: 8:30 am - 5:00 pm Hours Per Pay Period: 80 On Call: No Weekends: No

Clinical Grievances RN - Behavioral Health (PST, MST, CST or AZ)

UnitedHealthcare Colorado Springs, CO

$60,200 - $107,400 / year

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As the new Clinical Grievances Nurse, you will be responsible for reviewing incoming member cases to determine if the appropriate care was given. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. This role is a fully remote position but must be located in PST, MST, CST or AZ and able to work Monday-Friday 8A-5P within their time zone . Primary Responsibilities Perform clinical assessment of healthcare services provided to our members for appropriateness Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported Facilitate telephonic discussion with health care providers and/or members to obtain additional clinical information Provide timely, quality service to members and providers while upholding UnitedHealthcare culture values Act as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Function as a member of a self-directed team to meet specific individual and team performance metrics Manage and maintain quality and productivity metrics You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Current, unrestricted RN license in the state of residency Experience working in the Behavioral Health field as an RN 3+ years of total RN experience including clinical experience in an inpatient / acute setting Demonstrated clinical documentation skills and critical thinking skills Demonstrated proficiency in computer skills - Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel, and Outlook Designated workspace and access to install secure high speed internet via cable / DSL in home Live in CST, PST, MST or AZ and work 8-5 in their time zone Preferred Qualifications Bachelor's in Nursing or higher Experience with Managed Care Clinical Quality Programs Case management experience Clinical appeals and grievances experience Audit / chart review experience Experience in a telecommuting role Demonstrated ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Telehealth

Full-time

1 day ago

Senior Clinical Quality RN - Eastern Missouri - Remote

UnitedHealthcare St. Louis, MO

$72,800 - $130,000 / year

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This role reports to Quality Leadership and is responsible for ongoing provider education related to HEDIS and pay for performance (P4P) measures, as well as state-mandated and accreditation-related quality requirements. The Sr. Clinical Quality RN will serve as a liaison to establish trusting relationships with MO C&S providers to problem-solve and provide resources to support improved member quality outcomes. This role will also support additional health plan initiatives such as medical record reviews, external quality audits, and clinical data integration. If you live in Missouri , and willing to travel 25% of the time to cover Eastern Missouri , you will have the flexibility to work hybrid* as you take on some tough challenges. Primary Responsibilities Representing the health plan in meetings with healthcare providers to promote health plan quality initiatives and Value-Based care programs, and to provide needed resources to support improved member quality outcomes Monitoring and reviewing Patient Care Opportunity Reports (PCOR) with providers to facilitate member preventative wellness and closure of care gaps Supporting health plan initiatives to maximize HEDIS rates and achieve P4P targets both prospectively and during the medical record chase process retrospectively Coordinating remote and onsite provider medical record reviews to assess compliance with documentation standards, service delivery, billing and coding practices, and quality standards Collaborating with internal health plan partners on clinical quality initiatives, such as those related to Performance Improvement Projects (PIPs), data integration efforts with providers, CAHPS, and NPS improvement Representing the health plan at community events when needed You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Current unrestricted RN licensure in Missouri 5+ years of clinical experience in any setting 3+ years of quality experience (performance improvement, HEDIS performance measures, chart review, team facilitation, etc.) Knowledge of one or more of the following: clinical standards of care OR preventive health standards, OR HEDIS, OR NCQA, OR regulatory requirements Intermediate proficiency in software applications that include, but are not limited to, Microsoft PowerPoint, Microsoft Word, Microsoft Excel, Microsoft Outlook, and Internet browsers Proven ability to interact with internal and external customers in a professional manner Proven ability to develop provider relationships Proven effective presentation skills and experience providing outcomes data to senior leadership Proven self-motivated and have ability to work well both independently and with others as a team Willing or ability to travel up to 25% of the time to provider locations within a designated area, as well as other areas when needed to meet the needs of the team Reside in or within commutable driving distance to St. Louis, MO area, surrounding county in state of Missouri, or the Missouri Eastern Region Preferred Qualifications Master's degree Managed care experience Experience working with Medicaid and/or Medicare populations in a managed care setting Experience with Clinical Informatics Advanced proficiency in Excel (i.e., pivot charts, graphs, &/or data manipulation and analysis) Proficiency in software applications that support HEDIS activities, including but not limited to, Tableau, and vendor platforms Proven bilingual - English/Spanish All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Telehealth

Full-time

2 days ago

Care Coordinator Registered Nurse - Remote in Michigan

McLaren Health Care Flint, MI

Department: Care Coordinator RN (Remote in Michigan) Position Summary: As an advocate for the patient, the RN care manager will assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet an individual’s health needs, using clinical and community resources to promote quality, cost effective outcomes. Integrates evidenced based clinical guidelines, preventive guidelines, and protocols, in the development of individualized care plans that are patient centric.Provides targeted interventions to avoid hospitalization and emergency room visits. Essential Functions and Responsibilities: Provides telephonic and face-to-face comprehensive assessment and care management services to patients as part of an interdisciplinary team. Uses multi-dimensional assessment skills, risk assessment and screening tools to target high risk and vulnerable populations. Assesses over time the health care, educational, and psychosocial needs of the patient/caregiver.Uses standardized assessment tools such as depression screening, functionality, and health risk assessment. Provides follow up with patient/family when patient transitions from one setting to another.Completes timely post-hospital follow up: Medication reconciliation, PCP or specialist follow-up appointment, assess symptoms, teach warning signs, review discharge instructions, coordination of care, and problem solve barriers. Uses clinical judgment to determine level of care and collaborates with the PCP, patient and interdisciplinary team, including continuum of care settings and community. Required: RN with a valid unrestricted Michigan license. Three (3) years clinical nursing experience serving chronically ill patients and extensive knowledge of issues associated with chronic care and geriatrics. Preferred: RN, BSN. Three (3) years experience in a health plan or Physician Organization environment with care coordination, care management, and/or population health. Telephonic care management experience. Home care and/or hospice experience. Complex Care Management course completion or CCM. Additional Information Schedule: Full-time Requisition ID: 26003363 Daily Work Times: 8am-5pm Hours Per Pay Period: 80 On Call: No Weekends: No

Telehealth

Full-time

2 days ago

Virtual Acute Care Registered Nurse - Full Time - nights

Guthrie Big Flats, NY

$39 - $54.12 / hour

Acute Care Virtual Registered Nurse - the office and position is located in Big Flats, NY! This position is Full Time nights 6p-6a- 36 hours a week. This position is eligible for a $25,000 sign on bonus! Position Details: This Virtual Acute Care Registered Nurse must work out of the Big Flats NY office and will provide virtual support to bedside nurses at all Guthrie Hospital inpatient acute care (non-critical care) units. The Virtual Registered Nurse (RN) provides professional nursing care for patients in an acute care environment utilizing telecommunication technology. Collaborates with the bedside nurse to provide coordinated, safe, compassionate, therapeutic, evidence-based quality care to patients and families, based on individual physical, emotional, and spiritual needs, and appropriate care strategies throughout the lifespan. Practices in accordance with the Nurse Practice Act in the state of employment, the American Nurses Association (ANA) Code of Ethics for Nurses, and the ANA scope and standards of practice. Essential functions and specific skills for the job are found in the unit specific onboarding checklist and in standards that are applicable to the specialty. Education, License, & Certification - • Graduate from an accredited School of Nursing. BSN in Nursing preferred. - • Any previously agreed upon effective date for obtaining a bachelor's degree in nursing between individuals and facilities will remain in effect. - • Any contract with specific time frames for obtaining a bachelor's degree in nursing will supersede the above point and will remain in effect. - • Registered Nurse licensed in both the States of New York and Pennsylvania - • Specialty Certification is preferred - • Current BLS / ACLS required within 6 months - • Proficient with Windows-based computer skills and operation - • Proficient with EPIC documentation Experience - • 5 years of experience in acute care bedside nursing - • Specialty Certification required within 1 year - • Must maintain BLS / ACLS required within 6 months - • The Registered Nurse must meet the individual nursing unit specifications regarding educational requirements during employment. Essential Functions Employs Nursing Professional Practice: Utilizes clinical assessment skills and knowledge of EPIC and Sickbay functionality or designated software application, to monitor patients effectively and efficiently in collaboration with the patient's primary nurse. Utilize critical thinking skills and the specialized software to assess patients, and preemptively address subtle signs and symptoms of clinical deterioration or status changes. Develops updates and coordinates the patients' plan of care to achieve patient goals and to optimize outcomes and transitions across the continuum. Monitors, records, and communicates patient condition as appropriate. Advocates: Effectively advocates for ethical and holistic care by partnering in care planning to promote the autonomy, dignity, rights, values, and beliefs of those we serve. Communicates effectively to inform, coach, and support onsite nurses/clinicians, cultivating a therapeutic team approach. Facilitates Learning: Fosters a learning environment for patients/families, nursing, and other members of the healthcare team, including students. Facilities formal and informal learning for patients/families, nursing, other members of the healthcare team, and community. Serves as a clinical resource, coaches and mentors clinical nurses in areas of clinical and professional practice. Models' professional behaviors as a representative of the nursing profession. Aligns Practice with Safety and Quality: Manages assignment of complex patients and other unit demands. Proactively recognizes, determines a plan of action, and responds to routine, urgent, and emergent patient situations utilizing direct observation via videoconferencing, proactive surveillance of adverse physiological trends, medical chart review, and clinical alarms. Provides follow-up to ensure problem resolution. Engages in Professional Development: Engages in ongoing professional development; practices at the top of license within the legal parameters of the Nurse Practice Act, the ANA Code of Ethics for Nurses, and specialty standards. Promotes a culture of inquiry that explores, integrates, and disseminates research and evidence-based practice. Leader in Practice Setting & Community demonstrates leadership as change agents using the collaborative leadership skills of advocacy, influence, and innovation. Provides high level contributions to the onsite nurses' knowledge of pathophysiology, pharmacology, hemodynamics, bedside technology, and nursing care. It is understood that this description is not intended to be all-inclusive and that other duties may be assigned as necessary in the performance of the position. Other Duties 1. Proficiency in Information Technology, such as electronic health records, communication systems, computers, and equipment necessary to perform essential functions of the position. 2. Skilled to work with a wide range of staff as part of an interdisciplinary team, including physicians, nurses, and ancillary staff. 3. Ability to use independent, critical judgment in all aspects of patient care delivery. 4. Demonstrated interpersonal skills that convey a positive and supportive attitude. 5. Ability to effectively manage multiple responsibilities, urgent responses, and challenging situations. 6. Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of the job, especially regarding activities impacting patient or employee safety or security. 7. Hearing / Visual requirement The pay for this position ranges from $39.00-$54.12 per hour.