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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in comprehensive case management, patient-centered care coordination, and clinical assessment, with a strong focus on advocating for beneficiaries and optimizing care plans. Proficient in maintaining compliance with HIPAA and organizational policies while effectively collaborating with multidisciplinary teams.
Highest-signal resume keywords
Registered Nurse LicenseCase Management Certification (CCM)5+ Years Clinical RN ExperienceKnowledge of Case Management PracticesProficiency in Microsoft Office
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Comprehensive AssessmentsIndividualized Care PlansCare Plan CoordinationClinical DocumentationPatient-Centered CareComplex-Condition ManagementSelf-Care Management EducationResource CoordinationTelephonic Case ManagementAdaptability to Changing Priorities
Soft Skills
AdvocacyCollaborationCommunicationProblem-SolvingTeamwork
Tools & Technologies
Microsoft OfficeMobile TechnologiesMultiple Applications Navigation
Certifications & Qualifications
Registered Nurse LicenseCase Management Certification (CCM)
Industry Keywords
HIPAA ComplianceNCQA AccreditationURAC AccreditationBeneficiary AdvocacySelf-Determination
About the role
Key responsibilities & impact- Perform comprehensive assessments of beneficiaries and analyze findings to identify clinical, psychosocial, and behavioral concerns and gaps in care
- Develop and document individualized case management care plans with beneficiaries, families, physicians, and healthcare providers
- Document concerns, goals, interventions, resources, time frames, and barriers in care plans
- Coordinate and implement care plan activities to optimize benefits coverage and continuity of care across transitions
- Monitor, evaluate, revise, and update care plans to achieve desired outcomes
- Initiate care conferences with the Medical Director and multidisciplinary care teams for challenging cases
- Advocate for beneficiaries by promoting self-determination, informed decision-making, autonomy, and self-advocacy
- Educate and support beneficiaries in self-care management and access to care
- Identify benefit-related, educational, healthcare, and community resources and coordinate services
- Apply comprehensive case management, patient-centered care coordination, culturally sensitive care, and complex-condition management principles
- Collaborate with beneficiaries, caregivers, providers, multidisciplinary teams, and community resources
- Participate in training, professional development, team conferences, and meetings
- Maintain clinical documentation and data accurately and timely
- Comply with professional standards, organizational policies, privacy requirements, and HIPAA
Requirements
What you’ll need- Current, unrestricted Registered Nurse license in the state of residence and ability to obtain multi-state licensure
- United States citizenship status
- Ability to obtain required Security Clearance; current DOD Security Clearance preferred
- Associate or bachelor's degree in nursing from an accredited institution; bachelor's degree preferred
- 5+ years of clinical RN experience in direct patient care
- Knowledge of case management practices and patient-centered care concepts
- Proficiency in Microsoft Office, mobile technologies, and navigating multiple applications
- Ability to adapt to changing priorities
- Prior case management experience preferred
- Case Management Certification (CCM) preferred
- Experience working in an NCQA and URAC accredited case management program preferred
- Telephonic case manager experience at a health plan preferred
- Ability to work independently in a home office environment
- Must maintain CEUs as required by applicable State Boards of Nursing and required certifications
- Must adhere to applicable federal and state regulations, including HIPAA
Benefits
Comp & perks- Supportive, fast-paced, and innovative work environment
- Opportunity to work with experienced healthcare consultants
- Exposure to diverse client business areas
- Mentoring program with senior-level professional advisors
- Professional growth and development opportunities
- Ongoing training and professional development
- Team meetings and conferences
- Travel for team meetings and limited client onsite engagements (up to 5% annually)