• Medical Case Manager

    Job Locations US-RI-Smithfield
    Req No.
    NHPRI Department
    801 - Case Management
    Regular Full-Time
  • Overview

    Works collaboratively with the health care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.


    • Practice case management within the scope of licensure.
    • Utilizes case management principles and sound clinical judgment in coordinating care for a specific member population
    • Performs intensive case management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to:
      • Performing a comprehensive assessment
      • Care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, Behavioral Health Professionals and other involved health care professionals and community agencies, as appropriate
      • Implements care plan, facilitates referrals, coordinates services and resources and provides ongoing monitoring and re-evaluation of outcomes
      • Continuous monitoring and evaluation of the care outcomes and identification of service gaps
      • Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings
      • Off-site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required
    • Provides comprehensive documentation of all activities and contacts in Case Management software system
    • Facilitates referrals and coordinates needed services
    • Collaborates with team as necessary in identifying needed services and supports
    • Calculates cost savings that may result from redirecting member to a more appropriate care setting (i.e. PCP visit rather than ER)
    • Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers
    • Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner
    • Takes responsibility for professional development, supports a learning environment and meets professional competency requirements
    • Participates in department continuous quality improvement activities
    • Provides clinical oversight to community outreach and other team members; providing direct supervision of community outreach staff as appropriate regarding individual case status
    • Serves as a clinical resource to respond to questions from various departments
    • Provides cross-coverage as assigned
    • Participates in outreach/marketing activities as needed and as appropriate
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents


    • Registered Nurse with an active, current, unrestricted license in RI in good standing OR
    • LICSW with active, current, unrestricted license in RI in good standing
    • PC based software programs – intermediate level of proficiency
    • Organizational skills – strong skillset
    • Customer service orientation
    • Strong interpersonal skills


    • Two to Four (2-4) years’ experience in acute care
    • RN with Bachelor’s Degree or Certification as a CM
    • LICSW with an active, current, unrestricted license in Rhode Island in good standing
    • Clinical specialty experience


    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.


    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org


    Neighborhood is an EOE M/F/D/V and an E-Verify Employer


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