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Nurse Care Manager
4 months ago
Position DescriptionPosition Title: Nurse Care ManagerFull-time ExemptSupervisor: Director of Managed Care and Network Development
Position Summary: The Nurse Care Manager is responsible for developing patient care plans while providing patient education, guidance, and support, as well as maintaining a comprehensive care plan.
Responsibilities:
- Help close AWV gaps.
- Utilize patient information with the goal of achieving 4-star level performance in each medication adherence measure.
- Use nursing assessment skills to help guide care decisions while working collaboratively with an interdisciplinary care team to provide supportive care to patients.
- Outreach to patients to schedule annual wellness visits.
- Ensure that medical services are managed effectively and that the plan of care addresses the clinical condition and psychosocial needs of patients to maximize the goals of care.
- Monitor patient progress against plan of care goals with an emphasis on patient care needs during transitions and health changes.
- Manage transitions of care and other care management services.
- Support contracted provider care management team on the use of payer analytics and reporting and incorporate contracted provider’s internal analytical tools into pre-visit planning to improve gap closure at AWVs.
- Work directly with contracted providers and attributed members to removing barriers to filling medications appropriately.
- Work on other HEDIS campaigns in coordination with the contracted provider’s care management team.
- Work closely with the Health Plan Quality Practice Advisor in the coordination of activities to meet STAR goals.
- Provide feedback to providers on risk-adjustment and quality coding opportunities, in coordination with contracted provider coders.
