Onsite Clinical Care RN Position Available In Laurens, Georgia

Onsite Clinical Care RN Veracity Benefits Dublin, GA 31021

Job Title:

Clinical Care RN Reports to:

Chief Clinical Officer Status:

Full-time exempt with benefits

Location:

In-office Dublin, GA Schedule:

40 hours per week/Monday-Friday/8:30am-5:00pm

ET Salary Range:

$72k-$80k annually

Start Date:

June 9, 2025

Description:

The Clinical Care RN position is responsible for conducting case management activities in accordance with Veracity Benefits policies and procedures. The position responsibilities include the management of complex, acute assigned cases to ensure the member is being provided with quality, cost-effective health care services to reach optimal health outcomes. The position responsibilities also include coordinating with provider offices to assist members in receiving timely and quality care for their health care needs. The Clinical Care RN will work closely with the employer group to provide clinical expertise and guidance to the employer sponsor health benefits.

Qualifications:

Registered Nurse with a clear, active and unrestricted license in state of Georgia Multi-state Compact RN license preferred (required upon hire) A Bachelors (or higher) degree in a health-related field Certification in Case Management (CCM) or equivalent preferred (required within one year of hire) Minimum of five (5) years direct member care experience in an acute care or hospital-based setting Three (3) to five (5) years of case management or related experience Experience working in a managed care setting preferred Strong Problem-solving skills are essential Excellent typing, computer and documentation skills Ability to coordinate and communicate with a multidisciplinary team (internal and external) Ability to multi-task is essential

Duties:

Coordinate and facilitate member care through assessment, evaluation, planning and implementation via telephonic case management activities. Communicate member needs to care team members and follow up accordingly. Assist with facilitation of discharge planning when necessary. Collaborate with member, family members, physicians, and other care team members to ensure optimal health outcomes. Provide education and support to assist member with managing conditions and symptoms. Provide guidance and education on how to navigate the healthcare system as well as information regarding the member’s plan benefits and resources available to them. Coordinate access to providers, community resources, and health benefits as necessary. Provide interventions with the goal to avoid poor health outcomes, reduce readmissions, reduce unnecessary, costly treatment, manage transitions of care, and improve the member’s overall knowledge of their current condition with a focus on enhancing overall wellness. Collaboration and communication with providers regarding member needs. Identification of those members/members who require assistance with facilitation of discharge planning and referral to appropriate parties and/or programs as necessary. Analysis of the place of care to determine if member is going to the most appropriate, cost-effective facility and referral to outreach staff to assist that member in discussing alternative treatment locations as needed. Identifies and communicates high-cost claimants to the appropriate points of contact. Maintain regular contact with member and care team members. Coordinate with internal departments to ensure coordination of care for member’s clinical needs using a wrap-around approach to member care. Accurately and clearly document care management activities included but not limited to member, family member, physician and other team member discussions, review of medical records, emails, faxes, letters, coordination of services, linkage of resources, advocacy, education, and negotiations. Assess and summarize member health status, prognosis, treatment plan and anticipated costs. Research and provide cost-savings resources such as alternative funding programs, manufacturer assistance, and grants when available. Advocate for appropriate level of care when required. Assess and act accordingly in response to barriers and psychosocial issues. Develop a plan of care to include interventions and projected cost-savings. Communicate with Medical Director or Physician Advisor or appropriate leadership personnel when there is a threat to member safety or member health concerns. Participate in regular clinical rounds, staff meetings, and committee meetings. Participate in providing feedback and input into care management program services, procedures, and resource needs. Advocate on behalf of the member to secure access to quality, cost-effective care and attainment of treatment goals. Maintain confidentiality in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Coordinate with stop-loss/reinsurance carriers to provide accurate health status, prognosis and anticipated costs as part of the employer group renewal process.

Job Type:

Full-time Pay:

$72,000.00 – $80,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Medical Specialty:

Medical-Surgical Supplemental Pay:

Bonus opportunities Application Question(s): Confirm that you have reviewed the salary range, work location and start date as these are firm and non-negotiable.

Education:

Bachelor’s (Preferred)

License/Certification:

RN License (Preferred) Ability to

Commute:

Dublin, GA 31021 (Required)

Work Location:

In person