- Identifies members appropriate for Care Management by using targeted chronic conditions, level of care, and recognition of member’s disease-specific and preventative measures, knowledge base, or deficits in monitoring health, wellness, and chronic conditions. Reviews and analyzes clinical indicators and whether there is any ‘gap’ in compliance that will result in member contact.
- Performs telephonic nursing assessments utilizing the nursing process.
- Assesses symptoms utilizing evidence-based tools to determine dispositions and comfort measures.
- Develops and implements the care plan.
- Monitors the care plan to determine if the goals are being met on an ongoing basis to evaluate for needed changes and updates the plan of care accordingly. Closes the plan of care when complete.
- Collaborates with Medical Director when appropriate (i.e., communicates review findings, criteria not met, use of alternative care settings, determining the appropriate level of care, delay of provision of services, etc.) to ensure appropriate, coordinated service delivery.
- Identifies members requiring post-hospital services and initiates discharge planning with attending physician and designated hospital personnel.
- Coordinates appropriate post-hospital services.
- Conducts outbound calls to members to complete telephonic assessments and provide interventions and education to manage their health, wellness, and chronic conditions.
- Collaborates with the Provider or their designee to address the care plan from an integrated approach.
- Identifies and reports quality of care issues to the Medical Director and the VP of Medical Management.
- Communicates and collaborates with Medical and Nursing staff.
- Promotes the mission, philosophy, goals, and policies of the organization through staff education.
- Completes clear and concise documentation in Care Management programs.
- Participates in the quality care conference program.
- Provides clinical oversight of the care plan and care coordination process implemented by the Care Coordinator.
- Maintain personal, professional development.
- Collaborates with providers and/or the Medical Director when appropriate (i.e., communicating review findings, criteria not met, use of alternative care settings, determining the appropriate level of care, delay of provision of services, etc.) ensure appropriate, coordinated service delivery.
- Participates in departmental QIP process
- Provides clinical oversight of the call coordination process initiated by the call coordinators
- An active participant in the Care Integration Platform
- Performs other duties as assigned
- Must possess a current and active nursing license to practice in the state(s) assigned or maintain a compact license.
- RN license preferred
- CCM highly desirable
- 3+ years of various clinical experience.
- Ability to quickly ascertain the severity of illness
- Ability to utilize nursing skills to understand and coordinate the care of those significantly physically compromised by their illness and/or disability.
- Accountable and autonomous.
- Ability to handle multiple demands of diverse workload and prioritizes critical issues.
- Ability to effectively communicate verbally and in writing.
- Ability to build effective collegial relationships.
- Ability to influence and effect change.
- Ability to analyze and think critically.
- Possesses current knowledge of disease pathophysiology, psychosocial issues, and treatment.
- Good time management skills.
- Positive, service-oriented attitude.
- High level of integrity.
- Computer literate
- Must maintain valid driver’s license and vehicle.
- Able to develop, implement, communicate and evaluate a plan of care for each call
- Ability to maintain a HIPAA compliant professional work environment
Healthcare trailblazer. Top 100 workplace. Fastest growing private company. We’ve been called them all. Here’s one that we’re most proud of: We’re a company that lives our purpose of helping communities thrive.
- Our communities deserve more than the increasingly broken healthcare system we have inherited.
- Innovation must connect the healthcare experience to move people the right way on their health journey.
- Healthcare is better when people are known.
- Those who have earned the most trust will produce the most meaningful change.
Every day, our team works to turn those beliefs into actions that are poised to change the way people think about and receive healthcare. Every day, we support people’s health journeys by authentically living our values: Purpose Driven, Relationships Matter, Serve Others First and Inspire Creativity.
Our inclusive and vibrant culture empowers team members strive, perform and have a lot of fun on the way.
If this connects with you, we’re looking for exceptional talent with a growth mindset … people who are ready to make an impact. We look forward to meeting you!
(if you already have a resume on Indeed)