Chronic Condition Management Specialist

3 days ago

Independence, Missouri, United States Hines & Associates Inc Full time
{"title": "Chronic Condition Manager Role Overview", "content": "

Hines & Associates, Inc. is a nationwide, independent leader in personalized managed health care, focused on delivering comprehensive services with program excellence and cost containment.

As a Chronic Condition Manager, you will utilize your clinical nursing experience to develop a plan for meeting the health care needs of patients, while continuing to professionally grow in health care knowledge and perspective.

This key role involves utilizing medical knowledge to assess patients and provide individualized coaching for the purpose of developing a plan for meeting the health care needs and patient's goals of self-management of chronic medical conditions.

The Chronic Condition Manager is accountable for telephonic assessment, planning, implementation, coordination, education, monitoring, evaluation, and outcomes measurement.

Key responsibilities include:

  • Identifying problems while assessing the patient's medical and psychosocial status, including environmental and cultural influences.
  • Determining economically responsible options available to meet the patient's medical and care needs.
  • Collaborating with physician(s), provider(s), and patient/family and payers to facilitate quality, timely, and efficient medical care across the healthcare continuum.
  • Implementing disease management plans by coordinating resources, including community resources, healthcare providers, and significant others.
  • Evaluating the disease management plan and its effects on the patient and making modifications as necessary.
  • Improving health outcomes and quality of life with reduced complications and costs for persons with chronic health conditions.
  • Promoting patient self-management of chronic health conditions through individual assessment, education, and use of motivational interviewing principles/techniques.
  • Utilizing clinical practice guidelines and promoting best care for people with chronic medical conditions.
  • Demonstrating ability to communicate effectively with TPAs, insurers, physicians, patient/family, and other healthcare providers, including ability to negotiate with assertiveness.
  • Effectively communicating the disease case manager's impressions of methods available to provide for the medical needs of the individual patient or the need to refer to a higher level for review of questionable plans of treatment.
  • Providing written documentation concerning the information obtained regarding the patient's status, treatment plan, and disease management interventions.
  • Interfaces with UM, CM, and peer review, and other programs, as indicated on active cases.
  • Communicating knowledge of policy and procedure, standards of practice, and their revision; Participates in annual HIPAA, ethics, cultural, and URAC standards training.
  • Providing good customer relations by promoting good will and understanding between claimant, payer, 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 the disease management plan 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.
  • 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.

Physical requirements

  • No significant physical exertion required.

Hines welcomes diversity and as an equal opportunity employer, all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability, or protected veteran status.

"}

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