Uncubed
           

Complex Case Management Nurse

Oscar, Los Angeles, CA

A better kind of health insurance company


The Complex Case Management Program is consistent with the case management industry guidelines: assessment, care planning, communication and coordination, education, empowering and advocacy. The goal of this program is to improve quality outcomes and optimize service utilization and cost.

  • The assigned Registered Nurse (RN) will operate within the company’s Clinical Care Delivery department providing onsite and telephonic care management services to individuals identified as “high risk members”
  • Serve as the primary point-of-contact for a selected group of members and their families
  • Will travel between the office, member's homes and acute and subacute facilities
  • Will participate in twice weekly meetings with Medical Director to review member’s progress, update the plan of care as needed

Primary Responsibilities

  • Obtains consent from the member/family for participation in Complex Case Management
  • Develops 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
  • Evaluates expected outcomes and associated costs of the plan of care as well as any proposed alternative plan of care and makes necessary revisions
  • Initiates 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
  • Routinely conduct telephonic, in-home, and/or in-facility visits to monitor the member’s adherence to their established care plans
  • Continuously coordinates, monitors, tracks and evaluates all care and services rendered to ensure that quality care is being delivered in the most appropriate setting
  • Routinely discuss members’ care plans with the Medical Director to make adjustments as necessary
  • Manages 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
  • Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker
  • Identifies and addresses pharmacological and DME needs of the members and facilitates consultations with the pharmacy department, as necessary
  • Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and specialist visits
  • Be available (during work hours) to take incoming phone calls from assigned members (phone expense TBD)

Requirements

  • Active, unrestricted RN or LVN (BSN preferred) license in Florida, Tennessee, or California

Willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)

  • Two years case management at a managed care plan or provider organization and
  • Excellent communication skills to effectively interact with members, families, and external healthcare providers
  • 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
  • Strong working knowledge of Milliman Care Guidelines
  • Highly organized and self-motivated to effectively manage multiple members
  • Adherence to all member privacy and confidentiality standards of practice (i.e. HIPAA)

About Oscar

Founded in 2012, Oscar is probably the last thing you would expect from a technology startup – a seemingly old-fashioned healthcare insurance provider. The company provides clients with the kind of clarity and simplicity we have come to expect from an e-commerce site. And, of course, they're hiring.


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