Apply📍 United States
💸 57700.0 - 107800.0 USD per year
🔍 Healthcare
- Bachelor’s degree in nursing or RN certification in lieu of bachelor's degree or Master’s degree in Social Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.
- OR Bachelor’s degree in Social Work with five years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations
- Experience working with high-risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics
- 3 years of experience in working in Acute Care/Managed Care/Medicaid and Medicare populations.
- Bilingual English/Spanish language skills (Preferred)
- Case Management Certification (Preferred)
- Communicate effectively while performing customer telephonic interviewing and communication with external contacts.
- Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.
- Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States
- Educate members to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes.
- Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care.
- Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs.
- Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member.
- Develop an individualized plan of care designed to meet the specific needs of each member.
- Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated.
- Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services.
- Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention to develop a realistic plan of care.
- Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination.
- Maintain a working knowledge of available community resources available to assist members.
- Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible.
- Work within a Team Environment.
- Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services to enhance professional knowledge and competency for overall management of members.
- Participate in departmental and/or organizational work and quality initiative teams.
- Case collaborate with peers, Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.
- Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources.
- Foster effective work relationships through conflict resolution and constructive feedback skills.
- Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable.
- Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served to foster constructive and collaborative solutions to meet member needs.
- Other duties as assigned or requested.
Communication SkillsAnalytical SkillsProblem SolvingCustomer serviceOrganizational skillsTime ManagementWritten communicationMultitaskingDocumentationComplianceCoachingInterpersonal skillsAdaptabilityRelationship buildingTeamworkEmpathyActive listeningStrong communication skillsCross-functional collaboration
Posted 4 days ago
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