Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Case Manager is responsible for providing patient centered care across the care continuum.
- Assessment or data collection for the assessment of the medical, social, and behavioral needs of an assigned population
- Care Plan development or support to transition members to optimal levels of health and self-management.
- Capacity to coordinate interdisciplinary team meetings as required
- Collaboration across providers and healthcare settings to ensure optimal quality outcomes for an assigned population
- Provide transition of care interventions as required
- Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
- Facilitate linkage to appropriate community resources to address social determinants of health
- Capacity to adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting
- Able to ensure member communication and notices are composed in a manner consistent with regulatory standards.
- Adheres to the Policies and Procedures set forth by the Quality Management Committee
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Associate’s degree in Nursing, Bachelor’s degree preferred
- Minimum two (2) years of experience in medical management clinical functions.
- Working knowledge of MCG, InterQual, and NCQA standards
LICENSURES AND CERTIFICATIONS
- Active and Unrestricted License as a Registered Nurse (RN) or Licensed Vocational Nurse (LVN)
- Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
- Some travel may be required.
- Ability to lift at least 50 pounds.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.