RN Case Manager
On-siteErie, Pennsylvania, United States
Job Summary
Screen incarcerated individuals for eligibility under Waiver 5121 and the CMS 1115 Reentry Waiver, maintaining a real-time tracking log of eligible populations. Coordinate services across medical, behavioral health, and substance use disorder treatment while serving as the primary liaison between the facility clinical team, County Behavioral Health, Medicaid Managed Care Organizations, and community providers. Develop individualized Reentry Care Plans including medication continuity and follow-up appointments, then facilitate Medicaid enrollment and prior authorizations prior to release. Link patients to community-based treatment providers for direct warm hand-offs and confirm follow-up attendance. Maintain accurate documentation of all activities in the EMR and tracking systems in compliance with HIPAA, CMS, and correctional policies. Track key performance indicators including care plan completion, Medicaid activation, and recidivism reductions. Participate in multidisciplinary conferences, case reviews, and quality assurance audits while advocating for patient needs and overcoming barriers to care.
Required Qualifications
- Bachelor's degree in Nursing, or related field
- Registered Nurse (RN) licensure
- Minimum of 2–3 years of experience in case management, behavioral health, substance use disorder treatment, or correctional healthcare
Desired Qualifications
- Master's degree
- RN licensure (if not already required by the specific sentence context, though the text says 'preferred' for the degree and 'preferred' for the license, but the first sentence says 'Bachelor's... required' and 'RN preferred'. Let's re-read carefully: 'Bachelor's degree... (required); master's degree preferred.' 'Licensure preferred: RN... Registered Nurse (RN) preferred.' 'Case Management Certification (CCM) preferred.' 'Minimum of 2–3 years... (preferred).' 'Knowledge of Medicaid... strong...
- Case Management Certification (CCM)
- Knowledge of Medicaid, waiver programs (including Waiver 5121 and CMS 1115), and MCO processes
- Familiarity with MAT programs (e.g., methadone, buprenorphine, naltrexone), trauma-informed care, and motivational interviewing
- Experience working with justice-involved individuals or in correctional settings
- Must pass a background check and obtain facility clearance
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