PALLIATIVE RN CARE MANAGER

Telephonic Clinical Care Management Services

Provides telephonic clinical care management services using evidence-based practices to ensure patients receive appropriate, high-quality care that allows them to remain safely in their homes or communities.

Key Responsibilities

• Coordinate and oversee the delivery of benefits and services for assigned members.
• Complete comprehensive care management and disease-specific assessments.
• Make timely telephonic care management calls based on patient risk level.
• Resolve and coordinate complex member issues impacting care delivery.
• Provide health education and coaching to members and caregivers.
• Assess social determinants of health (SDoH) and coordinate care to address barriers.
• Identify member safety issues and connect to appropriate resources (therapy, DME, behavioral health, etc.).
• Ensure high-quality, cost-effective care aligned with evidence-based clinical guidelines.
• Advocate for members and caregivers to obtain needed health services.
• Promote adherence to physician treatment plans through education and support.
• Reduce inappropriate ER and hospital utilization by increasing access to preventive and primary care.
• Participate in interdisciplinary team (IDT) meetings and case discussions.
• Maintain confidentiality of all member information and ensure compliance with federal, state, and payor regulations.

Must have working knowledge of Medicare and Medicaid programs.