Chronic Condition Management Professional
1 week ago
About Hines & Associates Inc.
Hines & Associates Inc. is a reputable and independent leader in personalized managed health care, committed to delivering comprehensive services with excellence and cost containment that meet your demands. With over three decades of innovative and professional health care expertise, we have established a reputation as an industry leader.
What We Offer
- A competitive salary of $70,000 per year, complemented by medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance benefits.
- A 401k plan with a company match, fully vested after one year, providing a secure financial future for you.
- Paid holidays and time off, allowing you to recharge and maintain a healthy work-life balance.
- No weekends or holidays, ensuring you can enjoy a more predictable schedule.
- A hybrid setting, allowing up to two days per week of remote work, promoting flexibility and comfort.
Job Overview
This Chronic Condition Manager role empowers you to utilize your clinical nursing experience to develop a tailored plan for meeting the healthcare needs of patients, while continually growing in healthcare knowledge and perspective.
In this key position, you will be responsible for utilizing medical knowledge to assess patients and provide individualized coaching to help them develop a plan for meeting their healthcare needs and self-managing chronic medical conditions.
Duties and Responsibilities
- Identify patient problems through assessment of their medical and psychosocial status, including environmental and cultural influences.
- Determine economically responsible options available to meet patients' medical and care needs.
- Understand 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 the disease management plan and its effects on patients, making modifications as necessary.
- Improve health outcomes and quality of life for individuals with chronic health conditions, reducing complications and costs.
- Promote patient self-management of chronic health conditions through individual assessment, education, and motivational interviewing principles/techniques.
- Utilize clinical practice guidelines and promote best care for people with chronic medical conditions.
- Demonstrate effective communication with TPAs, insurers, physicians, patients/families, and other healthcare providers, including assertive negotiation skills.
- Communicate disease case managers' impressions of methods available to provide for patients' medical needs or refer to higher levels for questionable treatment plans.
- Provide written documentation regarding patient status, treatment plans, and disease management interventions.
- Interface with UM, CM, and peer review programs as indicated for active cases.
- Communicate knowledge of policies and procedures, standards of practice, and revisions; participate in annual HIPAA, ethics, cultural, and URAC standards training.
- Provide excellent customer relations by promoting goodwill and understanding between claimants, payers, providers, and professional staff at all times.
- Maintain patient privacy, confidentiality, promote safety, and comply with policies and procedures, URAC standards, and other regulatory requirements.
- Accountable for and retains responsibility for disease management plans and processes when using assistance from support staff; provides input on support staff to supervisors.
- Special projects assigned by supervisor.
Qualifications
- Registered nurse with a current, unrestricted license to practice in the state or reciprocating state where the office location resides.
- Successful completion of disease management orientation program.
- Minimum of 2 years of full-time equivalent direct clinical care to consumers.
- Excellent communication skills.
- Basic typing/computer knowledge with a minimum keyboarding speed of 35 WPM.
- Previous disease management or case management experience is helpful but not required.
- Certification in CCM or CHC is encouraged.
Physical Requirements
- No significant physical exertion is required.
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