POSITION SUMMARY:
This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.
ESSENTIAL DUTIES AND RESPONSBILITIES:
- Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures.
- Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes.
- Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges.
- Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention.
- Coordination of services for members, including community resources and collaboration with other members of the care team.
- Educate members and their caregivers on conditions and self-management techniques.
- Initiate and participate in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT.
- Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.
Qualifications
EDUCATION AND EXPERIENCE:
- Active Registered Nurse license in the state of Oklahoma required
- Active multi-state RN license is preferred
- Previous experience in managed care/utilization management preferred
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources.
- Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals.
- Must be able to communicate, both orally and in writing, clearly and effectively
- Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
- Proven ability to work independently or as a member of a team.
WORK ENVIRONMENT:
Work is normally performed in a professional setting. Work involves standing and walking for brief periods of time, but most duties are performed from a seated position. Work may include occasional pushing and/or pulling, lifting, and carrying objects weighing up to 20 pounds. Work requires normal vision and hearing as might be required in typical conversational use along with finger dexterity and eye-hand coordination to operate a computer keyboard at a moderate skill level.
TRAVEL:
N/A
SUPERVISORY RESPONSIBILITY:
N/A
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Active Oklahoma RN license required; multi-state RN license preferred; managed care/utilization management experience preferred; strong communication, organization, and Microsoft Office skills.
Key Responsibilities
- conducting calls
- coordinating care
- educating members
Skills & Tools
Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Job Details
- Category: Healthcare Services - Nursing
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Oklahoma, United States
- Languages: English
About GLOBALHEALTH HOLDINGS LLC
A company providing care management services to improve long-term member wellness through coordination and advocacy. — Industry: Healthcare