HEALTHCARE CONSULTANT II

4 weeks ago

Richmond VA USA, United States Impresiv Health Full time
Title: Healthcare Consultant II – Nurse Case Manager

 

Must Be Located in Chesapeake, Portsmouth, or Suffolk, VA      

 

Schedule: Monday-Friday 8am-5pm

 

Description:

The Healthcare Consultant II – Nurse Case Manager will provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.

 

What You Will Do:

 

  • Responsible for face to face and telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
  • Develops a proactive course of action to address issues presented to enhance the short and long- term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
  • Services strategies policies and programs are comprised of network management and clinical coverage policies.
  • Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
  • Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
  • Reviews prior claims to address potential impact on current case management and eligibility.
  • Assessments include the member’s level of work capacity and related restrictions/limitations.
  • Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
  • Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
  • Utilizes case management processes in compliance with regulatory and company policies and procedures.
  • Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
  • Productivity and quality expectations.
  • Work requires the ability to perform close inspection of handwritten and computer generated documents.
  • Work requires sitting for extended periods, talking on the telephone, travel to member’s homes and typing on the computer.

What You Will Bring:

 

  • RN with current unrestricted Virginia state licensure required.
  • 3 years of clinical med surg or behavioral health experience.
  • Associate’s of Bachelor’s Degree in Nursing required.
  • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
  • Effective communication skills, both verbal and written.

About Impresiv Health:

 

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

 

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

 

That’s Impresiv

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