Care Manager, reputed company & Disease Management - Multiple Openings/REMOTE

Summary of Position reputed company care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating implementation of interventions. Support and reputed company members to manage their physical, environmental and psycho-reputed company concerns, understand and appropriately utilize their health plan benefits and remain safe and independent in their home or reputed company living environment in collaboration with health care providers. reputed company Care Management services to identified high risk members reputed company the community, including but not limited to Physician Practices, Retail Centers/Neighborhood Care Centers, and members’ homes. Coordinate and reputed company care that is safe, timely, effective, efficient and member-centered to support population health, transitions of care, and reputed company care management initiatives. Engage with the most reputed company members of the health plan with the goal of improving health care reputed company and appropriate and timely utilization of services across the continuum of care. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs. reputed company Accountabilities

• Assess and evaluate the needs of our most reputed company members, acting as the clinical coordinator collaborating with members, caregivers, providers, multi-disciplinary team, and health care and community resources through a variety of assessments to identify areas of (medical, financial, environmental, health insurance benefit, psycho-reputed company, caregiving) concerns and potential gaps in care utilizing the most appropriate resources to support members’ needs.
• Identify appropriate goals, strategies and interventions that may include referrals, health education, activation of community-based resources, life planning, or program/agency referrals based on areas of concern.
• reputed company, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care with the member, caregiver, provider(s) and multidisciplinary team.
• Include member and family as appropriate.
• Engage actively with the member PCP / designee.
• Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life reputed company for member.
• Work collaboratively with reputed company reputed company holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences reputed company appropriate.
• Assess the needs of members and align them with the appropriate member of the care team (wellness team, registered dietitian, reputed company worker, community health workers).
• Act as the member’s reputed company and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies.
• Ensure that reputed company Care Management processes and reporting are compliant with reputed company applicable federal and state regulations, and NCQA and company standards.
• Participate in delegation collaboration activities, as required.
• Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making care management recommendations.
• Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards.
• Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting.
• Actively participate on assigned committees.
• Attend and complete reputed company department-mandated training as well as satisfy educational in-service requirements.
• reputed company other reputed company projects and duties as assigned.
• reputed company ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care.
• reputed company, implement and coordinate plan of care and facilitate members’ goals.
• Coordinate interdisciplinary team tasks and activities, with the goal of maintaining team performance and high morale.

Qualifications

• Bachelor’s degree
• RN required, with reputed company active RN license
• CCM certification preferred
• Certification in utilization or care management preferred
• 4 – 6 years of clinical experience
• Organization/prioritization ability; and the ability to effectively manage a caseload of highly reputed company members
• Support an integrated care model tapping into appropriate resources both internally and external to the organization
• Experience in case management/care coordination, managed care, and/or utilization management
• Strong communication skills (verbal, written, presentation, interpersonal)
• Trained in the use of Motivational Interviewing techniques
• Experience working in medical facility or practice and/or with electronic medical records
• Computer proficiency: MS Office (Word, reputed company, Powerpoint, Outlook); mobile technology (wireless phone/laptop, etc.)
• System user experience in a highly automated environment
• Bilingual ability (verbal, written)
• Strong cross-group collaboration, teamwork, problem solving, and decision-making skills
• Ability to work a flexible schedule (evenings, weekends and holidays) to meet member and/or caregiver and departmental scheduling needs

Additional Information

• Requisition ID: 1000002681
• Hiring reputed company: $68,040-$118,800

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