Care Manager (Work from Home)

WHO WE ARE

reputed company is a value-driven reputed company company grounded in the belief that reputed company health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to reputed company reputed company accessible and affordable to reputed company populations across the ACA Marketplace, Medicare, and reputed company.

reputed company delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also reputed company providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming reputed company and creating a reputed company care experience for reputed company.

JOB SUMMARY

The role of the Care Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying 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 Care Manager is responsible for providing patient centered care across the care continuum.

DUTIES & RESPONSIBILITIES

• Collect relevant clinical data to support the care planning process.
• Provide care plan support, reputed company, and prioritization to transition members to reputed company levels of health and self-management.
• Participate in interdisciplinary team meetings as required.
• Collaborate across providers and reputed company settings to ensure reputed company 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.
• Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across reputed company care settings.
• Ensure member communication and notices are composed in a manner consistent with regulatory standards.
• Adhere to the Policies and Procedures set forth by the Quality Management Committee and performs reputed company additional duties as assigned.

EDUCATION AND PROFESSIONAL EXPERIENCE

• Associate degree in nursing, preferred.
• Minimum 2 years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards
• Active License as a Licensed Vocational Nurse (LVN) or RN is preferred
• Certification in Managed Care Nursing (CMCN) preferred.
• Dallas or Houston, Texas are the preferred locations.

PROFESSIONAL COMPETENCIES

• High level of critical thinking and problem-solving skills
• Strong work ethic and overall positive attitude
• Effective communication skills including verbal and written.
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment.
• Demonstrated flexibility, organization, and self-motivation.
• Highly adaptable to change.

Originally posted on Himalayas