Rn Complex Case Manager (Within Ky Counties: Hopkins, Muhlenberg, Ohio)

Job Description
Acentra seeks an RN Complex Case Manager in Kentucky to join our growing team.
Job Summary:

The RN Complex Case Manager will:
Provide in-home, in-person care coordination in defined areas of coal mine states and telephonic care coordination across the United States. An integrated case management model (including care coordination/case management and disease management) assists the Funds team in maintaining beneficiaries at their most optimal functional level.
Foster an environment that incorporates the Funds' “caring” philosophy in all aspects of the case management process and coordinates care with the beneficiary and his/her provider to stabilize health status with the goal of maximizing his/her functional capacity and improving the overall quality of life.
Responsible for assessing, planning, implementing, and evaluating options and services to create an appropriate, individualized plan for the beneficiary across the continuum of care.
Facilitate, coordinate, integrate, and manage integrated case management and disease management activities based on the CMSA definition, philosophy, and guiding principles for case management.
PLEASE NOTE:
This is a full-time, direct hire, exempt, Hybrid opportunity with Benefits.
The selected candidate is required to reside within a one-hour drive of one of the following Counties within Kentucky:
Hopkins, Muhlenberg, or Ohio.
Phone and Travel for In-Home Visits/In-person Care Coordination
The percentage of In-Home, In-Person Care Coordination visits is up to approximately 25%.
The percentage of Telephonic Care Delivery across multiple time zones within the U.S. is up to approximately 75%.
Travel will be to specific counties within Kentucky:
Hopkins, Muhlenberg, or Ohio., with a drive time distance of up to a one-hour radius maximum (with mileage reimbursement).
Hours:
8:
00 AM – 5:
00 PM Central Monday-Friday.
The primary COVID-19 vaccination is required as you will work with beneficiaries in person.
Job Responsibilities:

Use independent nursing judgment and discretion to address, resolve, and process problems impeding the diagnostic or treatment progress, including medication set-up, blood pressure checks, pulse, temperature, and weight checks to support the home program.
Seek consultation from physicians, specialists, pharmacists, and other disciplines as necessary to facilitate care to optimize beneficiary function or prevent further decline in health.
Develop beneficiary-centered care plans demonstrating shared accountability between beneficiaries, caregivers, and providers.
Coordinate health and social services, coach the beneficiary and families, advocate for the beneficiary, educate the beneficiary and family, clarify, and assist with physician care plans, and communicate status and plans among the care team and resources, as indicated.
Conduct visits in the beneficiary’s home. Visits to hospitals, nursing homes, and physicians’ offices as necessary to continue the plan of care and support transition.
Review the care plan and progress in regular care conferences, emphasize transitions to other programs, and teach self-management/family caregiver management of chronic conditions to optimize functions, improve health, prevent further decline, or remain in the community.
Ensure day-to-day processes are conducted in accordance with the Utilization Review Accreditation Commission (URAC) and other regulatory standards.
The above list of accountabilities is not intended to be all-inclusive. It may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.