Chronic Illness Care Coordinator RN
2 weeks ago
About Hines & Associates, Inc.
Hines is a prominent, independent organization specializing in personalized managed health care, dedicated to delivering comprehensive services that prioritize your needs while ensuring program excellence and cost efficiency. With over three decades of experience, Hines & Associates, Inc. has established a reputation as a leader in innovative and professional health care.
What We Provide
- Attractive salary and comprehensive benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
- 401k plan with company matching, fully vested after one year.
- Paid holidays and time off to promote work-life balance.
- Flexible work arrangements, including a hybrid model allowing up to two days of remote work per week.
Position Overview
The Chronic Condition Manager role enables you to leverage your clinical nursing expertise to create tailored plans that address the health care needs of patients, while fostering your professional growth in health care knowledge and perspective. Embrace the opportunity to be the patient advocate you aspire to be.
In this pivotal position, the ideal candidate will utilize their medical knowledge to evaluate patients and provide personalized coaching aimed at developing strategies for managing chronic medical conditions. Responsibilities include telephonic assessments, planning, implementation, coordination, education, monitoring, evaluation, and measuring outcomes. The Chronic Condition Manager acts as a patient advocate, ensuring safety and maintaining privacy and confidentiality in line with established policies and procedures.
Key Responsibilities
- Assess the patient's medical and psychosocial status, identifying potential issues influenced by environmental and cultural factors.
- Explore economically viable options to meet the patient's medical and care requirements.
- Comprehend policy and benefit plans as well as healthcare systems.
- Collaborate with physicians, providers, patients, families, and payers to ensure quality, timely, and efficient medical care throughout the healthcare continuum.
- Implement disease management strategies by coordinating resources, including community services, healthcare providers, and significant others.
- Evaluate the effectiveness of the disease management plan and make necessary adjustments.
- Enhance health outcomes and quality of life while minimizing complications and costs for individuals with chronic health conditions.
- Encourage patient self-management of chronic conditions through individualized assessments, education, and motivational interviewing techniques.
- Utilize clinical practice guidelines to promote optimal care for individuals with chronic medical conditions.
- Demonstrate effective communication with third-party administrators, insurers, physicians, patients, families, and other healthcare providers, including the ability to negotiate assertively.
- Document the patient's status, treatment plans, and disease management interventions clearly and accurately.
- Engage with utilization management, case management, and peer review programs as necessary.
- Stay informed about policy and procedure standards, participating in annual training on HIPAA, ethics, cultural competency, and URAC standards.
- Foster positive customer relations by promoting goodwill and understanding among claimants, payers, providers, and professional staff.
- Act as an advocate for patients, ensuring privacy, confidentiality, and safety while adhering to policies, URAC standards, and other regulatory requirements.
- Maintain accountability for the disease management plan and process, providing input on support staff to their supervisors.
- Participate in special projects as assigned by management.
Qualifications
- Registered nurse with a current unrestricted license to practice in the state or in a state with licensure reciprocity.
- Successful completion of a disease management orientation program.
- A minimum of two years of full-time equivalent direct clinical care experience.
- Strong communication skills.
- Basic typing and computer skills with a minimum keyboarding speed of 35 WPM.
- Previous experience in disease management or case management is beneficial but not mandatory.
- Certification in CCM or CHC is encouraged.
Physical Requirements
- No significant physical exertion is required.
Hines is committed to diversity and is an equal opportunity employer. All qualified applicants will be considered without regard to race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability, or protected veteran status.
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