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Title: RN Case Manager: Special Needs Plan

Location: United States – Remote – Full-Time

Job Description

A bit more about this role:

We want to help members navigate the healthcare system in a better and safer way, and case management is critical to achieving this for our most vulnerable and complex members. You’ll be responsible for providing telephonic, ongoing case management support to our highest risk members, and you’ll be helping to build the program while doing so. You’ll focus initially on the members enrolled in our Dual Eligible Special Needs Plan (D-SNP). These members, eligible for both Medicaid and Medicare, represent some of the highest risk members who would most benefit from case management. You’ll serve as an advocate for these members, coordinating care and ensuring they have the necessary resources and support to achieve better health outcomes.

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

A day at Devoted could include:

Working with members

• Engaging with high-risk members (primarily telephonically) to understand their needs, supported by technology and data tools.
• Conducting holistic assessments to identify comorbid conditions, ED/hospitalization history, medications, psychosocial factors, and member values and preferences.
• Developing care plans in partnership with members and their caregivers – problems, goals, interventions – while continuously evaluating the member’s progress.
• Explaining complicated medical terms in plain language.
• Educating members on their chronic conditions including teaching “red flags,” developing plans during an exacerbation, and identifying barriers to important care elements such as medication adherence.
• Preparing members for their inpatient and outpatient treatments.

Working with other providers and resources

• Working closely with Devoted Community Guides (locally-based social workers) to identify community-based organizations to support our members in meeting their goals.
• Coordinating post-treatment care and DME needs.
• Collaborating closely with our PCP partners, as well as Devoted Medical Group, to coordinate care and deliver evidence-based, effective, and accessible health care.

Improving how we work

• Providing feedback and advice to help improve the operational processes, software tools, and data capabilities to improve how Devoted does transitions of care case management.

Attributes to success:

• A desire to make a change in the healthcare experience: you love to serve and make a difference.
• You enjoy being on the phone caring for patients.
• Strong clinical skills that will help you understand what a patient needs to help her avoid poor health outcomes.
• The ability to adjust your tone and approach to different people in order to build trust and achieve positive outcomes.
• The ability to articulate and break down complex information to ensure patients and caregivers are able to absorb and act on your guidance.
• Excellent organizational skills which you will use to prioritize and provide need-based levels of engagement with inidual patients, communicate and coordinate care needs across various organizations, and ensure none of our members fall through the cracks.
• Proven success and enjoyment in building relationships with a variety of stakeholders, such as care managers at hospitals and care coordinators at large PCP groups. The ability to learn quickly from past experiences and implement changes for improvement.
• You are comfortable working with technology and in a dynamic, startup environment.
• Comfort or interest in working remotely post COVID

Desired Skills and experience:

• An unrestricted, compact RN license and willingness to obtain non-compact state licenses if needed.
• Prior case management experience with DSNP population.
• The ability to comfortably multi-task: you’ll be listening, talking and typing all at the same time.
• Team player mentality with a can-do attitude.
• Bilingual in English and Spanish a plus
• Health insurance experience, particularly Medicare Advantage a plus.
• Experience working with dual eligibles in some capacity.