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Healthcare Case Management Specialist
2 months ago
Position Overview:
The Healthcare Case Management Specialist serves as the primary coordinator for a multidisciplinary team focused on managing complex healthcare needs. This role is essential in directing high-risk members to suitable resources, services, and programs. The specialist evaluates and formulates comprehensive care strategies to ensure effective health service delivery across various settings. Collaboration with an integrated team is key to facilitating seamless communication among providers, members, and caregivers, ultimately aiming to enhance quality, reduce expenses, and improve the overall member experience.
Qualifications:
EDUCATIONAL BACKGROUND
Diploma in Nursing or Bachelor of Science in Nursing (BSN)
CERTIFICATION & LICENSURE
Must hold a Registered Nurse license in the state of Illinois. Professional licensure is required in the regions where Carle Health operates. Obtaining Case Management certification within 24 months is highly recommended.
EXPERIENCE
A minimum of two (2) years of nursing experience in clinical, healthcare, or social service environments is required. Experience in case management is preferred.
SKILLS AND COMPETENCIES
Proficient understanding of the roles of various healthcare disciplines and the ability to coordinate care across multidisciplinary teams. Strong problem-solving skills and adaptability are essential. The ability to engage members in discussions about lifestyle changes while being culturally sensitive is crucial. Competency in Motivational Interviewing is expected. Must be capable of identifying and utilizing additional resources to meet member needs. Advocacy skills are essential for this role.
Key Responsibilities:
- Oversees both Medicare Advantage and Commercial members.
- Coordinates and manages intricate medical cases and healthcare requirements throughout the care continuum.
- Conducts thorough member assessments, identifies gaps in care, and collaborates with physicians and the integrated team for ongoing care coordination.
- Develops personalized care plans in collaboration with members and their primary care providers.
- Maintains comprehensive documentation to ensure continuity of care.
- Assists members in establishing a local support network to help manage their long-term health independently.
- Monitors and tracks essential coordination tasks for complex cases, transitioning members to monitoring status or other programs as appropriate.
- Acts as the lead coordinator for the multidisciplinary care team, directing high-risk members to appropriate resources and services.
- Focuses on prioritized complex cases as determined by further analysis.
- Creates care plan summaries and effectively communicates them with primary care providers and members.
- Assigned to specific geographic areas or service locations as needed.
Carle Health is an Equal Opportunity Employer and prohibits discrimination against any employee or applicant based on race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, disability, or any other protected class. Carle Health participates in E-Verify to confirm work authorization.
Effective September 20, 2021, the COVID-19 vaccine is a requirement for all new team members. Exemptions for medical or religious reasons will be considered.
