Note - Remote Anywhere in US - Work in PST Time Zone but MUST CA RN License in addition to compact.
Position Purpose
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):
Experience Working with Medicare/Medicaid
Assisting with Backlog-referrals from CA-members sending referrals to case managers
Will be Assigned 5-10 referrals daily.
Ability to work in Fast paced environment.
Case Management exp required.
At least four -5 hours a day are spent on outbound phone calls reaching out to members.
Calls are recorded-will have audio audits.
Data entry-tracking data
Case load requirement is 75-(will be ramped up to this amt)
Develop, assess and adjust, as necessary, the care plan and promote desired outcome.
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options.
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs.
Provide patient and provider education.
Facilitate members’ access to community-based services.
Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems, treatment and provider options.
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs.
Provide patient and provider education.
Facilitate members’ access to community-based services.
Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
Education/Experience
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
Licenses/Certifications: Current state’s RN license.
Describe the performance expectations/metrics for this individual and their team:
Calls are audio recorded and must have seventy-five cases at a time.
What previous job titles or background work will be in this role?
Case Manager, Transitions of Care, Utilization Management, Disease Management
Position Purpose:
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Develop, assess, and adjust, as necessary, the care plan and promote desired outcome.
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options.
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs.
Provide patient and provider education.
Facilitate members’ access to community-based services.
Monitor referrals made to community-based organizations, medical care, and other services to support the members’ overall care management plan.
Actively participate in integrated team care management rounds.
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Qualifications.
Education/Experience:
Graduate from an Accredited School of Nursing.
Knowledge of healthcare and managed care preferred.
Prior experience working in a remote role preferred.
Prior case management experience preferred, and Bilingual in Spanish and English is preferred.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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