Care Management Specialist II

We are seeking a highly skilled and compassionate Care Management Specialist II to join our team. As a Care Management Specialist II, you will play a critical role in ensuring that our members receive high-quality, coordinated care that meets their unique needs. This is an exciting opportunity to make a positive impact on the lives of our members and to be part of a dynamic team that is dedicated to delivering exceptional care.

Overview

As a Care Management Specialist II, you will be responsible for discharge care coordination, episodic case management, and pre-admission/post-discharge counseling for acute conditions. You will work closely with physicians, coordinators, and facility discharge planners to determine other resources and appropriate disposition of cases. You will also provide education, counseling, and referral to other resources to minimize re-admissions and emergency room episodes.

Required Skills

Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with current, active, unrestricted license in the state of operations (or reciprocity if applicable)
2 years clinical experience
1 year health insurance/managed care experience
Knowledge of medical management policies and procedures
PC and database experience
Verbal and written communication skills
Customer service skills and interpersonal skills to discuss pre/post admission care with physicians, hospital staff, and members
Ability and willingness to occasionally travel within assigned location
Possess transportation and current, valid driver's license for applicable state

Nice to Have Skills

Experience with case management software and electronic health records
Knowledge of community resources and local organizations
Bilingual or multilingual skills
Experience with quality improvement initiatives

Preferred Education and Experience

Bachelor's degree in Nursing, Social Work, or related field
Experience working in a healthcare setting
Knowledge of regulatory requirements and accreditation standards

Other Requirements

Ability to work independently and as part of a team
Strong communication and interpersonal skills
Ability to maintain confidentiality and handle sensitive information
Willingness to participate in ongoing education and training