Nurse Care Manager, Virginia Medicaid

Job Summary

The nurse care manager is responsible for coordination of appropriate, cost-effective services that enhance a members quality of life, focus on a members optimal level of independence, and reduces inappropriate utilization of medical services. The nurse care manager collaborates with members and the health care team to achieve evidence based clinical objectives and goals specific to preventative health measures and improved disease self-management.

Essential Responsibilities

In close collaboration with the member/members family, and members of the health care team, assesses the members health status, functional limitations, psychological status, social support systems, resources, environmental factors, and response to treatment. Uses motivational interviewing techniques to identify members readiness for change, creates appropriate care plan based on assessments, assists member with health system navigation and connection to community resources. Provides supportive counseling and education to members, families and caregivers, members of the health care team, and others including end-of-life issues and Advance Directives. Effectively manages and coordinates assigned caseload consistent with established criteria. Ensures consistent and reliable documentation of case management activities in compliance with all organization and department standards. Facilitates application process for accessing local, state, and federally funded programs (e.g., Medicaid, Medicare, Disability) and/or refers to appropriate community-based resources. Provides education and coaching to improve overall self-management, health, and wellness. Monitors chronic health conditions to achieve optimal self-management.

Basic Qualifications

• Experience Minimum two (2) years of experience in case management or three (3) years of clinical experience are required.
• For
• Virginia
• Medicaid: Minimum one (1) year of experience working directly with individuals who meet the
• Cardinal
• Care
• Priority
• Population criteria: Individuals involved with Child Protective Services, foster care, and/or former foster youth Individuals with Substance Use Disorder Youth with a mental health diagnosis Minimum one (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (Individuals with Substance Use Disorder, Youth with a mental health diagnosis, Individuals involved with Child Protective Services, foster care, and/or former foster youth) Education Associates degree in nursing required. License, Certification, Registration This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire. Registered Nurse License (Maryland) within 6 months of hire AND Registered