CCM Case Management RN
Job description
About the role
You will operate as a telephonic case management professional focused on member education and care coordination. In this capacity, you will guide members through complex healthcare transitions while prioritizing strict confidentiality and professional conduct at all times. The role involves direct outreach to individuals facing significant health challenges to improve their overall journey through the system. You will develop and manage outcome-based care plans in collaboration with clinical leadership and other departments. Additionally, you will act as a liaison between members and medical directors to secure necessary approvals and remove barriers to care. This position requires active participation in process improvement initiatives and the evaluation of new pilot programs as they emerge. You will also educate internal teams on CCM protocols to ensure a high standard of member service across the organization.
Key facts
What you'll do
Coordinate care across diverse settings including emergency rooms, inpatient facilities, post-acute locations, outpatient clinics, and home care services.
Initiate contact with members undergoing difficult health challenges to guide them through the healthcare system and enhance their overall experience.
Perform comprehensive biopsychosocial needs assessments to identify the full scope of member requirements.
Create outcome-driven plans of care based on member input and clinical assessments, with targeted timelines for achievement.
Proactively communicate with hospital case managers to facilitate safe discharges to appropriate levels of care or home environments.
Advocate for members by consulting with medical directors and acting as a problem-solver for barriers impacting compliance with care plans.
Educate other Oscar teams on the CCM program to identify and support high-risk members effectively.
Collaborate with non-clinical teammates to assist members in navigating the healthcare system and demonstrate how to add value to member interactions.
Deliver education to members regarding health conditions, new medications, and medical procedures via phone, secure messaging, and in-person meetings.
Engage in surveys, studies, and special projects as assigned by management to support organizational goals.
Requirements
Possess two or more years of cumulative clinical experience prior to the start of this role.
Maintain an active and unrestricted Registered Nursing license in the state of hire with the ability to obtain additional licensure as necessary.
Demonstrate the ability to uphold confidentiality and the highest level of professionalism when handling sensitive member information.
Show competence in utilizing telephonic communication to deliver effective member education and support.
Adhere to Oscar Health's standards for ethical conduct and care coordination excellence.
Commit to working within the specified remote location parameters and attending occasional team meetings or company events.
Understand the importance of developing outcome-based care plans that are realistic and member-centered.
Acknowledge the necessity of advocating for members to ensure they receive appropriate and timely care.
Nice to have
Working knowledge of Milliman Care Guidelines to facilitate accurate care coordination.
Prior case management experience in similar healthcare environments.
Possession of a CCM certification and a Bachelor of Science in Nursing (BSN).
Documented success working remotely with comfort and proficiency in accessing company systems.
Fluency in Spanish or Creole to better serve diverse member populations.
Practical notes
This is a remote position open to candidates residing in Arizona, Florida, Georgia, and Texas.
Internal candidates located outside these states may apply if they meet all job requirements and internal transfer eligibility criteria.
Occasional travel may be required for team meetings and company events.
The base compensation for this role ranges from $32.60 to $42.79 per hour.
Employees are eligible for monthly vacation accrual at a rate of 15 days per year.
About the role
You will operate as a telephonic case management professional focused on member education and care coordination. In this capacity, you will guide members through complex healthcare transitions while prioritizing strict confidentiality and professional conduct at all times. The role involves direct outreach to individuals facing significant health challenges to improve their overall journey through the system. You will develop and manage outcome-based care plans in collaboration with clinical leadership and other departments. Additionally, you will act as a liaison between members and medical directors to secure necessary approvals and remove barriers to care. This position requires active participation in process improvement initiatives and the evaluation of new pilot programs as they emerge. You will also educate internal teams on CCM protocols to ensure a high standard of member service across the organization.
Key facts
What you'll do
Coordinate care across diverse settings including emergency rooms, inpatient facilities, post-acute locations, outpatient clinics, and home care services.
Initiate contact with members undergoing difficult health challenges to guide them through the healthcare system and enhance their overall experience.
Perform comprehensive biopsychosocial needs assessments to identify the full scope of member requirements.
Create outcome-driven plans of care based on member input and clinical assessments, with targeted timelines for achievement.
Proactively communicate with hospital case managers to facilitate safe discharges to appropriate levels of care or home environments.
Advocate for members by consulting with medical directors and acting as a problem-solver for barriers impacting compliance with care plans.
Educate other Oscar teams on the CCM program to identify and support high-risk members effectively.
Collaborate with non-clinical teammates to assist members in navigating the healthcare system and demonstrate how to add value to member interactions.
Deliver education to members regarding health conditions, new medications, and medical procedures via phone, secure messaging, and in-person meetings.
Engage in surveys, studies, and special projects as assigned by management to support organizational goals.
Requirements
Possess two or more years of cumulative clinical experience prior to the start of this role.
Maintain an active and unrestricted Registered Nursing license in the state of hire with the ability to obtain additional licensure as necessary.
Demonstrate the ability to uphold confidentiality and the highest level of professionalism when handling sensitive member information.
Show competence in utilizing telephonic communication to deliver effective member education and support.
Adhere to Oscar Health's standards for ethical conduct and care coordination excellence.
Commit to working within the specified remote location parameters and attending occasional team meetings or company events.
Understand the importance of developing outcome-based care plans that are realistic and member-centered.
Acknowledge the necessity of advocating for members to ensure they receive appropriate and timely care.
Nice to have
Working knowledge of Milliman Care Guidelines to facilitate accurate care coordination.
Prior case management experience in similar healthcare environments.
Possession of a CCM certification and a Bachelor of Science in Nursing (BSN).
Documented success working remotely with comfort and proficiency in accessing company systems.
Fluency in Spanish or Creole to better serve diverse member populations.
Practical notes
This is a remote position open to candidates residing in Arizona, Florida, Georgia, and Texas.
Internal candidates located outside these states may apply if they meet all job requirements and internal transfer eligibility criteria.
Occasional travel may be required for team meetings and company events.
The base compensation for this role ranges from $32.60 to $42.79 per hour.
Employees are eligible for monthly vacation accrual at a rate of 15 days per year.