The RN Complex Care Manager's role will comprise of diverse job functions and program assignments designed to meet specific contractual and program related requirements which includes an approach that treats the population as a whole. Although, the CCM is a direct report under Population Health Management, the CCM works in a matrixed relationship and is accountable for meeting the goals, criteria, and business protocols of the with other supporting departments served. The CCM will address the promotion of health and wellness and the prevention of disease. This position is responsible for providing intensive nursing care management and/or collaborative consultation to support individuals in identified as Complex Care Members that are high risk or high cost.

Required Experience:

• Minimum of two (2) years of experience working with the MH/SU/IDD population
• Minimum of three (3) years of experience as a Registered Nurse
• Knowledge of NCQA is preferred

Requirements:

• A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts.
• Problem solving, negotiation, arbitration, and conflict resolution skills are essential to balance the needs to both internal and external customers.
• Must be highly skilled as shifting between macro and micro level planning, maintaining both the big picture and seeing that the details are covered for assigned duties/projects.
• Must exhibit an understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version), the MH/SA/DD service array, and the application of physical health interventions provided through the network of providers.
• Understanding of NCQA components/requirements, and NC/Federal Regulations are essential as they relate to job duties/projects.
• The employee must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish.
• Work activities quickly change according to mandated changes and changing priorities within the department.
• The employee must be able to change the focus of his/her activities to meet changing priorities.
• Proficiency in Microsoft products (such as Word, Excel, Outlook, PowerPoint, etc.) is required.
• Ability to independently excel at navigating new platforms as changes are made.

The RN Complex Care Manager is responsible for (but not limited to) the following:

Reviews member information within the platform, updates information to meet requirements of NCQA, as needed and/or informs the appropriate staff when inaccuracies are found.

Facilitate comprehensive assessments of members' needs and evaluate results to determine the appropriateness and effectiveness of care

Ensures the initiation and continuance of integrated care plans that incorporate a member's physical health, mental health, social supports, lifestyle, community involvement, and risks to well-being, among others.

Encourages member engagement in assessments and care plans.

Provide intensive care management/care coordination and follow up to assigned members as a consultant or care manager within specialty programs or regional care teams

Assist members in choosing providers.

Participates in multidisciplinary care team meetings to ensure members receive the benefits and services of care management including access to services, establishment of self-management goals, and navigation support within the health care system.

Provides education about all available services and natural and community supports, treatment options, diagnosis, etc.

Provides education on chronic conditions, medication management and disease management to support coordination of benefits and services.

Develops and cultivates working relationships with service providers and community other community partners.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or

844-463-6178

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Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.