Based on the evolving situation with Covid-19 we are mostly remote, this includes the hiring process. We are in the process of moving to a hybrid of onsite and remote with some positions remaining 100% remote.
A Registered Nurse that will work to enhance the quality of member management, maximize both satisfaction and cost effectiveness, and assist in navigating the health care system as a collaborative partner in their health care team. As a RN Case Manager, the RN will work closely with clients and members alike in order to promote wellness, problem-solve, and assist members in realization their personal health-care related goals. The role includes patient and provider outreach, data collection, analyzation, and reporting, clinical review, medical and behavioral health assessments, and documentation in compliance with Federal, state regulations, and NCQA standards for client members seeking healthcare treatment and services. This position is part of a team in the Value Based Care Department.
What Success Looks Like:
In 3 Months• Ability to work primarily autonomously with completion of daily assignments with daily/weekly interaction and oversight from preceptor• Basic knowledge and ability of navigation of UM/PHM Plan, MSA, processes, resources, EMR, and documentation platforms.• Ability to autonomously perform telephonic outreach, documentation and log reviews• Emerging skills in reporting and cross-departmental communications with other clinical departments.
In 6 Months• Ability to autonomously perform UM meeting prep and presentations.• Ability to perform daily tasks in an organized and efficient manner while adhering to departmental processes and the UM/PHM Plan.• Effective and professional communication with members, clients/providers, and collaborative departments with ability to build rapport telephonically.
In 12 Months• Experienced collaboration skills in reporting and cross-departmental communications.• In depth knowledge of the HMO product, HMO and departmental process, MSA, UM/PHM plan with associated annual expectations of change,• In depth knowledge of contracted IPAs with ability to cross over into each one as needed.• Ability to assist in departmental process creation and process improvement with ability to generate forward thinking attitude and an understanding of productivity, incentives, and departmental goals and outcomes.
What You'll Be Doing

• Coordinating and providing case management and care that is timely, effective, efficient, equitable, safe, and member centered.
• Managing case assignments (outreach, documentation, case progression, and case closures), meeting reporting and documentation standards, and engaging in collaborative meetings with clients.
• Assisting members in reaching wellness and autonomy with their medical and behavioral health care, addressing barriers, social determinant of health, member motivators, and psychosocial issues.
• Help members make informed decisions by acting as their navigator through the healthcare system while promoting quality and cost-effective interventions and outcomes.
• Identify targeted members into organized Population Health Management programs, provide case management services and ensure navigation through the continuum of care.
• Responsible for supporting operational aspects of the division to meet the organization's customer requirements and satisfaction.
• Maintain confidentiality related to all computer programs, medical records and data.
• Monthly attendance and coordination of QM/UM Committee Meetings including material preparation, minutes, data collection and analysis, reporting and follow-up tasks.
• Assist with the Quality Improvement studies and participate in quality management activities
• Rotation in after-hours calls and weekend transition of care calls (if applicable).
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
• Other responsibilities as assigned

What You'll Bring

• Current Illinois Registered Nurse License (State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year license renewal cycle).
• Five years of experience in a variety of health care settings.
• Excellent knowledge of case management principles, healthcare management, and reimbursement components, with experience in motivational interviewing,
• Excellent clinical judgment, as well as highly skilled in verbal and written communication.
• Strong organizational. problem solving, and time management skills necessary.
• Ability to ensure timely completion of projects and assignments.
• Ability to prioritize and react based on rapidly changing business needs.
• Must have ability to work independently and remotely with multi-tasking skills for fast paced workflows.
• Must possess software knowledge including word processing and spreadsheets, computer skills including MS Word, Excel, Access, PDF, Outlook, etc.
• Experience navigating multiple EMR's.
• A high speed/secured home internet connection, a home office with a door that locks for security and privacy purposed, and back-up connection service options for internet outages (this may include driving into the Rockford office on short notice).

Would Love For You To Have

• Knowledge of utilization review, quality improvement, managed care, and/or community health.
• Previous Case Management experience.
• Previous remote and/or telephonic work experience.

What You Get

• Join a high performing team who brings all data into one of the top Healthcare Analytics companies in the US.
• Learn a TON about healthcare and edge of healthcare analytics and medical economics.
• Become an expert in clinical healthcare data.
• Competitive compensation.
• Great benefits like flextime time off.
• Autonomous work environment based on trust and mutual respect with the ability of role progression and talent expansion.


This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

About Arcadia
Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website , our online resources , and our interactive Data Gallery .
This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.