Healthcare Advocate Coordinator RN
4 weeks ago
About Hines & Associates Inc.
Hines & Associates, Inc. is a nationwide leader in personalized managed healthcare, dedicated to delivering comprehensive services with exceptional program excellence and cost containment.
Our commitment to innovation and professionalism has earned us a reputation as an industry leader over three decades. We serve all aspects of the healthcare industry, striving to conserve healthcare dollars while ensuring quality care through effective programs and personalized service.
What We Offer
We provide a competitive salary and benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
Our 401(k) plan offers a company match, fully vested after one year. We also offer paid holidays and time off, promoting work-life balance without requiring weekends or holidays.
We operate in a hybrid setting, allowing up to two days per week of remote work.
Job Overview
The Chronic Condition Manager role enables you to utilize your clinical nursing experience to develop individualized plans for meeting patients' healthcare needs, while continuing to grow professionally in healthcare knowledge and perspective.
As a patient advocate, you will be responsible for utilizing medical knowledge to assess patients and provide coaching for developing plans that meet their healthcare needs and goals for self-management of chronic medical conditions.
The Chronic Condition Manager is accountable for telephonic assessment, planning, implementation, coordination, education, monitoring, evaluation, and outcomes measurement. You will promote safety, maintain privacy and confidentiality in accordance with policies and procedures.
Duties and Responsibilities
Identify problems while assessing patients' medical and psychosocial status, including environmental and cultural influences.
Determine economically responsible options available to meet patients' medical and care needs, understanding policy/benefit plans and systems.
Collaborate with physicians, providers, patients/families, and payers to facilitate quality, timely, and efficient medical care across the healthcare continuum.
Implement disease management plans by coordinating resources, including community resources, healthcare providers, and significant others.
Evaluate disease management plans and their effects on patients, making modifications as necessary.
Improve health outcomes and quality of life with reduced complications and costs for persons with chronic health conditions.
Promote patient self-management of chronic health conditions through individual assessment, education, and use of motivational interviewing principles/techniques.
Utilize clinical practice guidelines and promote best care for people with chronic medical conditions.
Demonstrate ability to communicate effectively with TPAs, insurers, physicians, patients/families, and other healthcare providers, including ability to negotiate with assertiveness.
Effectively communicate disease case managers' impressions of methods available to provide for the medical needs of individual patients or the need to refer to a higher level for review of questionable plans of treatment.
Provide written documentation concerning information obtained regarding patients' status, treatment plans, and disease management interventions.
Interface with UM, CM, and peer review, and other programs, as indicated on active cases.
Communicate knowledge of policy and procedure, standards of practice, and their revision; Participate in annual HIPAA, ethics, cultural, and URAC standards training.
Provide good customer relations by promoting goodwill and understanding between claimants, payers, providers, and professional staff at all times.
Acts as an advocate, maintains privacy, confidentiality, promotes safety, and is compliant with policies and procedures, URAC standards, and other regulatory standards.
Responsible for and retains accountability for disease management plans and process when using assistance of support staff; provides input on the support staff to their supervisor.
Special projects as assigned by supervisor.
Requirements:
- Registered nurse with current unrestricted license to practice in the state or in a state that has licensure reciprocation with the state of the office location that employee is working in.
- Registered Dietitian practices under current unrestricted registration as dictated by the Commission on Dietetic Registration.
- Successful completion of disease management orientation program.
- Minimum of 2 years full-time equivalent of direct clinical care to the consumer.
- Excellent communication skills.
- Basic typing/computer knowledge with minimum keyboarding speed of 35 WPM.
- Previous disease management or case management experience helpful but not required.
- Obtaining certification in CCM or CHC is encouraged.
Benefits
Competitive salary: $85,000 - $110,000 per year, depending on experience.
Comprehensive benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
401(k) plan with company match, fully vested after one year.
Paid holidays and time off, promoting work-life balance without requiring weekends or holidays.
Hybrid setting, allowing up to two days per week of remote work.
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