Job Description

Duties: For this position, Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members. Also assist those members experiencing the burdens of illness and injury. The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs assignments of a defined population.
The Case Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced.
Ability to work independently and effectively communicate to internal and external customers in a telephonic environment.
Skills: Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes.
Promote consumerism through education and health advocacy.
Assesses member's health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures.
Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
Demonstrates sensitivity to culturally diverse situations, clients and customers.

 
Keywords:
Education: Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Compact RN license is required.
Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research.
Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills.
Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making.
Excellent verbal and written communication and interpersonal skills.
Ability to learn new processes and systems quickly.
Strong time management and organization skills.
Ability to work in a rapidly changing environment.
Ability to work independently.
Ability to work with people with significant educational and or socioeconomic barriers impacting their health education.
Ability to demonstrate sensitivity to culturally diverse situations, participants, and customers.
Preferred requirements:
Ideal candidate would have previous case management experience with the Medicare/Medicaid population specifically focusing on Special Needs Plan. Model of Care documentation requirements, care coordination working with hospital settings and Primary Care Physician offices.
Two years full-time equivalent of direct clinical care to the consumer.
Bilingual (Spanish) certified.
CCM certified.
Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making.
Experience in medical management and case management in a managed care setting is highly desirable.
Knowledge of managed care products and strategies.
Effective coaching/education skills.
Working at home, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Experience Senior population Chronic conditions.
Skills and Experience:
Minimum Degree Required: Associate's Degree (

Job Tags

Full time,

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