Job Profile Summary
Position: Care Manager (RN Nurse- Care Manager)
Location: Pittsburgh, PA
Duration: 6 months
This job works directly with providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted in relation to quality and care costs. The incumbent could work in a physicians office, visit physician practices on a routine basis, work within a hospital setting and/or visit the members home. This job directly helps members with the highest risk scores to coordinate care and navigate the healthcare system by recommending and/or implementing interventions related to the improvement of medical care and costs.
Duties & Responsibilities
- Maintain oversight over specified panel of members by performing ongoing assessment of members' health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
- For assigned case load, create care plans to address members' identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
- Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
- Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
- Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
- Other duties as assigned or requested.
- High School Diploma/GED
- Professional experience, skills and qualifications:
- 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
- RN license in PA.
- Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
- Broad knowledge of disease processes
- Understanding of healthcare costs and the broader healthcare service delivery system
- Proficiency in MS Excel and computer skills.
- Strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
- Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
- Ability to work in a high performing team environment that requires flexibility
- Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management, problem solving, and project management skills
- Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy
- Educational requirements: Bachelor's Degree in Nursing
- Professional experience, skills and qualifications:
- Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
- Experience working with the healthcare needs of diverse populations
- Understanding of the importance of cultural competency in addressing targeted populations
- Experience working at either Quantum or Accolade
- Certification in Case Management
- Must be based in the Pittsburgh area
- Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state and local standards
- Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc.
- Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard and monitor
If you are interested in this position, please apply using the "Apply " option. If you have questions, or would like to speak with a Recruiter directly, send an email to the contact person below and note the job identification number in the subject line.
Gail.Rolls@cai.io (please note new e-mail address)
Talent Acquisition Manager
EEO Statement: It is the policy of Computer Aid, Inc.(CAI) not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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