Chronic Condition Care Specialist
1 week ago
About Us
Hines & Associates, Inc. is a nationwide leader in personalized managed healthcare, delivering comprehensive services with exceptional program excellence and cost containment.
What We Offer
- Competitive salary: $105,000 per annum, along with benefits including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
- 401k plan with company match, fully vested after 1 year.
- Paid holidays and time off.
- Work-life balance.
- No weekends or holidays.
- Hybrid setting; up to 2 days per week remote.
Job Overview
As a Chronic Condition Care Specialist, you will utilize your clinical nursing experience to develop individualized plans for meeting the healthcare needs of patients, while continuing to grow professionally in healthcare knowledge and perspective.
In this key role, you will be responsible for utilizing medical knowledge to assess patient status and provide coaching for developing a plan that meets the patient's healthcare needs and 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. You will act as a patient advocate, promoting safety, maintaining privacy and confidentiality in accordance with policies and procedures.
Duties and Responsibilities
- Identify problems while assessing the patient's medical and psychosocial status, including environmental and cultural influences.
- Determine economically responsible options available to meet the patient's medical and care needs.
- Understand policy/benefit plans and systems.
- Collaborate with physician(s), provider(s), and patient/family and payers to facilitate quality, timely, and efficient medical care across the healthcare continuum.
- Implement disease management plan by coordinating resources, including community resources, healthcare providers, and significant others.
- Evaluate the disease management plan and its effects on the patient, 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, patient/family, and other healthcare providers, including ability to negotiate with assertiveness.
- Effectively communicate 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.
- Provide 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.
- Communicate knowledge of policy and procedure, standards of practice, and their revision; Participates in annual HIPAA, ethics, cultural, and URAC standards training.
- Provide good customer relations by promoting goodwill 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.
Qualifications
- 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.
We welcome diversity and are an equal opportunity employer, considering all qualified applicants regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability, or protected veteran status.
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