Nurse Case Manager I - Case Management Specialist
Description:
Job Description
Description:
Looking for Columbus OH and immediate surroundingcounties.
The Care Manager Specialist is a member of the Care Team.The Care Manager Specialist is responsible for the care management of membersthat are enrolled in the Dual Special Needs Plan. These members are usuallystratified as low medium stratification, or those with Social Determents ofCare needs. The Care Manager will work in conjunction with the Nurse CareManager, Care Coordinator, Transition of Care (TOC) Coach, and other members ofthe Care Team to improve the members health outcomes, address socialdeterminants of health and connect members with community-based organizations.The Care Manager will assess members needs as well as gaps in care,communicate with the members Primary Care Provider (PCP), maintain updatedindividualized care plans, and participate in Interdisciplinary team meetings.Care Managers will be able to identify members whose needs require clinicianinvolvement and transition members appropriately.
Complete health screening questionnaires, assessmentswhich may be market specific.
Support reduction of population of unable to reachmembers by telephone and in -person visits.
Ensure member has filled/received their medication(s) andhas an understanding on how to take their ordered medications.
Manage caseload of members with current stratification ofmonitoring, low and medium or those with high social determinants of careneeds- frequency /contract guidelines
Provides clinical assistance to determine appropriateservices and supports due to members health needs (including but not limitedto: Prior Authorizations, Coordination with PCP and Specialty providers,Condition Management information and education, Medication management,Community Resources and supports)
Evaluation of health and social indicators
Identifies and engages barriers to achieving optimalmember health.
Uses discretion to apply strategies to reduce memberrisk.
Presents cases at case conferences for multidisciplinaryfocus to benefit overall member management.
Facilitates overall care coordination with the care teamto ensure member achieves optimal wellness within the confines of the memberscondition(s) and abilities to self-manage.
Coordinates resources, assists with securing DME, andhelps to ensure timely physician follow-up.
Understands Payer/Plan benefits, policies, procedures,and can articulate them effectively to providers, members, and other keypersonnel.
Updates the Care Plan for any change in condition orbehavioral health status.
Provide support to members in transitions of care
Duties
Responsible for interacting with low stratificationmembers via phone calls, coordinating care, completing, reviewing, and updatingassessments and care plans that address problems, goals, and interventions.Based on assessments and claims data creates a care plan for members to follow70%
Participate as a member of the Care Team duringInterdisciplinary Team meetings to discuss the members health care needs,barriers to care and explore better outcomes for the member 20%
Identify and link members with health plan benefits andcommunity resources 5%
Perform administrative work to maintain skills needed forjob duties 5% 5%
Experience
Required: 2 years LPN Nursing exp, preferred 3 + yearsexperience. Regular and reliable attendance
Familiar with community resources & services
Strong organizational skills
Works independently.
Maintains professional relationships with the members weserve as well as colleagues.
Communicates effectively and professionally verbally andin writing.
Proficient with computer systems
Knowledgeable in Microsoft Office Software
Excellent customer service skills
Has a dedicated home work space
Position Summary
Looking for Columbus OH and immediate surroundingcounties.
The Care Manager Specialist is a member of the Care Team.The Care Manager Specialist is responsible for the care management of membersthat are enrolled in the Dual Special Needs Plan. These members are usuallystratified as low medium stratification, or those with Social Determents ofCare needs. The Care Manager will work in conjunction with the Nurse CareManager, Care Coordinator, Transition of Care (TOC) Coach, and other members ofthe Care Team to improve the members health outcomes, address socialdeterminants of health and connect members with community-based organizations.The Care Manager will assess members needs as well as gaps in care,communicate with the members Primary Care Provider (PCP), maintain updatedindividualized care plans, and participate in Interdisciplinary team meetings.Care Managers will be able to identify members whose needs require clinicianinvolvement and transition members appropriately.
Complete health screening questionnaires, assessmentswhich may be market specific.
Support reduction of population of unable to reachmembers by telephone and in -person visits.
Ensure member has filled/received their medication(s) andhas an understanding on how to take their ordered medications.
Manage caseload of members with current stratification ofmonitoring, low and medium or those with high social determinants of careneeds- frequency /contract guidelines
Provides clinical assistance to determine appropriateservices and supports due to members health needs (including but not limitedto: Prior Authorizations, Coordination with PCP and Specialty providers,Condition Management information and education, Medication management,Community Resources and supports)
Evaluation of health and social indicators
Identifies and engages barriers to achieving optimalmember health.
Uses discretion to apply strategies to reduce memberrisk.
Presents cases at case conferences for multidisciplinaryfocus to benefit overall member management.
Facilitates overall care coordination with the care teamto ensure member achieves optimal wellness within the confines of the memberscondition(s) and abilities to self-manage.
Coordinates resources, assists with securing DME, andhelps to ensure timely physician follow-up.
Understands Payer/Plan benefits, policies, procedures,and can articulate them effectively to providers, members, and other keypersonnel.
Updates the Care Plan for any change in condition orbehavioral health status.
Provide support to members in transitions of care
Education
HS or equivalent, must be licensed LPN.
What days & hours will the person work in thisposition List training hours, if different.
M-F 8-5
Full-time