Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.
We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.
Position Responsibilities
Specific
Manage expenses, facilitate access and improve quality of life for persons with long-term chronic conditions and/ or high risk, high cost disease states (Disease and/ or Chronic Condition Management)
Work with patients in distinct populations and sub-populations to promote global outcomes, optimize health, manage care and control costs (Population Health)
Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination, case management
Educate member/caregivers about treatment options, community resources, insurance benefits, etc
Engage member to complete health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
Assess, develop, implement, document, coordinate, monitor, manage, evaluate and update comprehensive individualized care plans (ICP) designed to provide evidence based care to meet member needs
Employ ongoing assessment and documentation to evaluate member response to and progress on the ICP
Identify and manage barriers to achievement of care plan goals
Identify and implement effective interventions based on clinical standards and best practices
Collaborate with members of an inter-disciplinary care team (ICT) to identify member needs and opportunities that would benefit from care coordination to achieve goals and maximize member outcomes
Act as a liaison to collaborate with facility based case managers, provider and care transition/ discharge planners to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
Coordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of services
Appropriately terminate care coordination services based upon established case closure guidelines
Provide clinical oversight and direction to unlicensed team members as appropriate
General
Perform daily work with a focus on the core principles of managed care:
patient education
wellness and prevention programs
early screening and intervention
continuity of care
Work proactively to expedite the care process
Identify priorities and necessary processes to triage and deliver work
Empower members to manage and improve their health, wellness, safety, adaptation, and self-care
Assess and interpret member needs and identify appropriate, cost-effective solutions
Identify and remediate gaps or delays in care/ services
Advocate for treatment plans that are appropriate and cost-effective
Work with low-income/ vulnerable populations to ensure access to care and address unmet needs
Gather and evaluate clinical information to assess and expedite referrals within the healthcare system including consideration of alternate levels of care and services
Facilitate timely and appropriate care and effective discharge planning
Work collaboratively across the health care spectrum to improve quality of care
Leverage experience/ expertise to observe performance and suggest improvement initiatives
Ensure understanding of industry standard competencies and performance metrics to optimize decisions and clinical outcomes
Ensure individual and team performance meets or exceeds the performance competencies and metrics
Contribute actively and effectively to team discussions
Share knowledge and expertise, willingly and collaboratively.
Provide outstanding customer service, internally and externally
Follow and maintain compliance with regulatory agency requirements
Competencies
Position Qualifications:
Ability to translate member needs and care gaps into a comprehensive member centered plan of care
Ability to collaborate with others, exercising sensitivity and discretion as needed
Strong understanding of managed care environment with population management as a key strategy
Strong understanding of the community resource network for supporting at risk member needs
Ability to collect, stage and analyze data to identify gaps and prioritize interventions
Ability to work under pressure while managing competing demands and deadlines
Well organized with meticulous attention to detail
Strong sense of ownership, urgency, and drive
The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.
The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads.
The ability to offer positive customer service to every internal and external customer
Experience
Current unencumbered Compact RN license
Minimum of 5+ years of acute clinical experience
Minimum 2 years’ experience in a managed care environment across multiple lines of business (Medicare Advantage, Managed Medicaid, Dual SNP, Commercial, etc.)
2+ years of care management experience in managed care environment, CM certification preferred
Strong knowledge of care management/ population health processes and industry best practice
Detailed knowledge of SDOH frameworks and community resource networks
HMO and risk contracting experience preferred
In-depth knowledge of current standard of medical practices and insurance benefit structures.
Excellent oral and written interpersonal/communication, internal/external customer-service, organizational, multitasking, and teamwork skills.
Proficiency in Microsoft Office
Physical Requirements
Must be able to sit in a chair for extended periods of time
Must be able to speak so that you are able to accurately express ideas by means of the spoken word
Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
Must be able to fluently communicate both verbally and in writing using the English language
Time Zone: Eastern or Central
Other Information
Expected Hours of Work: Friday 8 am – 5 pm; with ability to adjust to Client schedules as needed
Travel: May be required, as needed by Client
Direct Reports: None
Salary Range: $70,000 - $100,000
EEO Statement
It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Business Consulting and Services
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