Case Manager

Job Tittle: Care Manager

Location: Remote

Duration: 3 Months Contract

Shift: 8AM 5PM (MonFri) (CST)

Position Purpose:

• Perform care management duties to assess plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality cost effective care.

Note:

• Compact licensure is needed.
• CA and OR RN licensures would also be a benefit if the candidate has those.
• To further explain my case management team is a specialty team.
• Our focus is calling Medicare members all over the US within 30 days from a hospital rehab or any other inpatient stay to follow up on any pending needs they have and to review their most recent medication changes following the discharge.
• We then send a medication reconciliation to their PCP via fax.
• All work is done remotely MonFri 8a5p. It is call after call so I need someone that is willing to make quite a few calls each day.

Walk me through the daytoday responsibilities of this the role and a description of the project (Outside of Workday JD):

• Outreach members by phone to review their needs following recent discharge and to complete a medication reconciliation.
• Outreach PCP offices to obtain a verbal medication list to complete a medication reconciliation on an unable to reach member.
• Refer members to traditional CM teams as needed.
• Complete a Transition of Care Assessment with member via phone calls.
• Outreach members in different time zones throughout the US from east coast to west coast.
• Describe the performance expectations/metrics for this individual and their team:
• Assignment to include 2030 tasks per day; minimum of eleven successful TOC/MRP assessments per day; audits of 90% or higher.
• Tell me about what their first day looks like:
• System specific training to learn the navigation of the system and where to document the information.
• What previous job titles or background work will be in this role
• Previous experience as a telephonic CM.
• Other experiences that would benefit include Home Health ER/triage Case Management and adult care.

Position Purpose:

• Perform care management duties to assess plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality cost effective care.
• Develop assess and adjust as necessary the care plan and promote desired outcome.
• Assess the members current health status resource utilization past and present treatment plan and services prognosis short and longterm goals treatment and provider options.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Develop plan of care based upon assessment with specific objectives goals and interventions designed to meet members needs.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased organizations medical care and other services to support the members overall care management plan.
• Actively participate in integrated team care management rounds.
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Enter and maintain assessments authorizations and pertinent clinical information into various medical management systems Qualifications.

Education/Experience:

• Graduate from an Accredited School of Nursing.
• Bachelors degree in nursing preferred. 2 years of pediatric clinical nursing experience in a clinical acute care or community setting.
• Knowledge of healthcare and managed care preferred.
• Prior experience working in a remote role preferred.
• Prior case management experience preferred and Bilingual in Spanish and English is preferred.