Care Manager
1 month ago
To be successful in this role, one must:
- Provide comprehensive care management and care coordination for a panel of high-risk patients with 2 or more chronic conditions. Coach patients to improve their health behavior to attain health-related goals.
- Apply the principles of comprehensive, patient-centered, community-based, developmentally appropriate, and culturally and linguistically sensitive coordination of services.
- Use case management processes to ensure quality care is delivered to patients, families, and caregivers in the most efficient and effective manner across the care continuum and within a virtual environment.
- Complete a comprehensive patient needs’ assessment for each patient and coordinate with the attending physician as needed.
- Develop and maintain relationships among patients, families and caregivers, and the patient’s care team.
- Telephonically engage patients, families, and their caregivers in understanding, establishing, and monitoring patient self-management care plans, as warranted.
- Document each patient’s individualized care plan and care coordination in the electronic database. Proactive engagement with patients, families, and caregivers to provide education and resources throughout the full continuum of care.
- Provide timely communication with patients and identified family representatives, as required.
- Communicate with and provide feedback to referral sources including physicians, advanced practice providers, behavioral health specialists, social services, employees, stop-loss carriers, and/or care coordinators, as appropriate.
- Assist the care team by helping to measure quality and identify, refine, and implement practice improvements.
- Demonstrate personal responsibility and respect for patients, families, caregivers, and co-workers.
- Demonstrate flexibility, enthusiasm, and willingness to cooperate while working with others in multi-disciplinary teams.
- Uphold HIPAA regulations and complies with federal and state regulatory bodies to support quality measure requirements.
- Adhere to all Department procedures regarding documentation.
- Take call on weekends and holidays, as needed.
Qualifications:
• Associate Degree in Nursing
• Current Registered Nurse license in state of residence – compact licensure as warranted
• Master of Social Work (MSW) or Licensed Clinical Social Worker (LCSW) will be considered in lieu of RN
• At least 3 years of clinical or patient services experience working with mental health disorders
• At least 3 years care/utilization management, health care customer service, and/or patientcentered medical home (PCMH) background is desired
• Knowledge of medical terminology • Excellent communication skills • Knowledge of post-hospital care and community resources
• Ability to prioritize independently and respond to multiple simultaneous requests • Computer proficiency with office applications and electronic medical record
• Ability to complete continuing education requirements as needed
• Ability to attend company, department, and team meetings as required, including industry training sessions
• Ability to comply with all company policies and procedures, proactively protecting confidentiality of Client and company information
• Ability to travel at least 10%
• Ability to work on a computer for a prolonged amount of time
• Ability to work outside of normal business hours as needed; weekend and holiday coverage, as assigned
• Legally able to work in the United States Preferred Qualifications:
• Bachelor Degree in Nursing
• 5+ years clinical or patient services experience working with mental health disor
Preferred Qualifications:
• Bachelor Degree in Nursing
• 5+ years clinical or patient services experience working with mental health disorders
• CCM Certified • Relevant TPA or payer experience
• 5 years care/utilization management, health care customer service, and/or patient- centered medical home (PCMH) background
• Certification in Case Management (CCM or ACM) • Mental health experience
• InterQual or MCG experience
• Bilingual in Spanish language • Knowledge of medical terminology, counseling/teaching, and family treatment skills
• Aptitude for managing human behavior change • Program development skills specific to the environment
Point C is a private equity backed platform of third-party administrators (TPAs) focused on providing services to businesses that self-fund their medical benefits. Point C actively acquires independent and 'like-minded' TPAs within the continental US encouraging each partner to retain their unique local identities while creating value at the platform-level through centralizing back-office functions, improving technology, and optimizing vendor relationships. Our mission is to support our TPA partners through business process innovations and product solutions that drive value for employers and enhance the member experience. At the heart of our mission is the individual—a person who deserves the same kind of support and care we would provide our own family. If you are interested in joining an amazing team, please apply today
#INDPE2023
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