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Complex Case Management Nurse

Company: Oscar Health
Location: Dallas
Posted on: October 19, 2020

Job Description:

Hi, we're Oscar. We're hiring a Complex Case Management Nurse to join our Clinical team in our Dallas Texas.

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

About this role:

The Complex Case Management Program's goal is to improve quality outcomes for our members and improve service use and cost. You will work in the Clinical Care Delivery department providing onsite and telephonic care management services to individuals identified as "high risk members." You will be the primary contact for a selected group of members and their families.

You will report into the Medical Director for Complex Case Management.

Responsibilities:


  • Develop an outcome-based plan of care, based on the member's input and assessed member clinical and social needs with anticipated targeted dates for accomplishment.
  • Evaluate expected outcomes and associated costs of the plan of care and any proposed alternative plan of care and makes necessary revisions.
  • Initiate onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team.
  • Conduct initial in-home or facility visit to engage and educate the member (and their family/caregivers) to the Complex Case Management program.
  • Conduct telephonic, in-home, or in-facility visits to monitor the member's adherence to their established care plans.
  • Coordinate all care and services provided to ensure that quality care is delivered in the most appropriate setting.
  • Manage transition of care ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member's health care status changes.
  • Identify and address psychosocial needs of the members and family and facilitates consultations with Social Worker.
  • Identify and address pharmacological and DME needs of the members and facilitates consultations with the pharmacy department.
  • Coordinate post-discharge clinic appointments, medication reconciliation, PCP and specialist visits

    Requirements


    • Active, unrestricted RN (BSN preferred) in the state of residency
    • Willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)
    • Two years of case management experience at a managed care plan or provider organization and
    • Ability to work effectively both on an individual basis and as part of a multidisciplinary team
    • Strong computer skills to maintain accurate and complete documentation in our Case Management record systems
    • Working knowledge of Milliman Care Guidelines

      Life at Oscar:

      At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

      We encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

      Reasonable Accommodation

      Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

      Pay Transparency Policy

      Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

Keywords: Oscar Health, Dallas , Complex Case Management Nurse, Executive , Dallas, Texas

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