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Clinical Case Manager
2 months ago
Join Our Team at TruHealth
TruHealth, a division of American Health Partners, operates across various states, providing a wide range of healthcare services.
Our organization encompasses nursing facilities, health plans for Medicare beneficiaries in long-term care, and specialized divisions for psychiatric care, home health, hospice, rehabilitation, and specialty pharmacy services.
We pride ourselves on offering competitive compensation, comprehensive benefits, and opportunities for career advancement.At TruHealth, we prioritize the well-being of our staff, recognizing their vital contributions through various reward and recognition initiatives.
The Clinical Case Manager is tasked with overseeing and facilitating the Case Management strategies for effective care coordination among members enrolled in a Medicare Advantage plan.
This role requires a proactive individual who excels in teamwork, can manage multiple tasks efficiently, works independently on assigned projects, and possesses outstanding communication and presentation abilities.
Benefits Offered:
- Annual performance-based salary increases
- 401k retirement plan with employer matching
- Comprehensive medical, dental, and vision coverage
- Paid time off
- UKG Wallet for quicker access to earnings
- Holiday compensation
- Telehealth services available at no cost to employees
- Opportunities for Continuing Education
- Pathways for Career Advancement
Qualifications:
- At least 2 years of clinical nursing or rehabilitation experience with the geriatric population.
- Minimum of 2 years of experience in managed care.
- 3-5 years of case management experience in a managed care setting, preferably with a managed care organization or similar facility.
Key Responsibilities:
- Conduct Health Risk Assessments for assigned members.
- Initiate, update, and revise care plans as necessary.
- Maintain an assigned patient caseload.
- Collaborate with an interdisciplinary health team to evaluate, coordinate, and plan patient care; reassess and adjust care plans as needed.
- Provide education to patients and families based on identified learning needs using available resources.
- Educate Home/Facility staff as needed based on identified learning requirements.
- Coordinate outpatient discharge planning according to patient needs, clinical situations, and benefit coverage.
- Participate in Managed Care audits; generate, maintain, and track periodic and annual reports/documents using MS Office, supporting the Care Coordination program.
- Engage in improvement projects involving the development of monitoring tools, medical record reviews, data entry, analysis, and preparation of audit findings and reports.
- Attend patient care conferences, committee meetings, and educational programs to enhance professional competency.
- Apply medical management criteria accurately.
- Research clinical inquiries from employers, members, and payers as necessary.
- Educate members about health access options.
- Manage and resolve daily challenges in care coordination, ensuring effective communication with the Facility/Home.
- Perform additional duties as assigned.
Education Requirements:
- Graduate of an accredited RN program.
- Bachelor's Degree is preferred.
Licensure and Certifications:
- Current RN license in the assigned state.
- Current CCM license is preferred.
- CPR certification for Healthcare Professionals.
- Valid driver's license.
- Current motor vehicle insurance.
