Identifies issues relating to members' physical and mental well-being that affects health status and works in collaboration with both the member and provider to determine appropriate care for case management services.
In collaboration with the member and PCP completes a comprehensive assessment and develops a care plan assessing short-term and long-term needs.
Acts as a leader during interdisciplinary care team conferences to achieve optimal clinical and resource outcomes.
Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
Maintains and documents initial assessment; designs a care plan that is attainable and in the appropriate business application program.
Acts as a liaison between physician and member to alleviate potential issues that can interrupt care
Maintains case load by identifying cases that are no longer high in intensity or services and closes them timely and appropriately.
Schedules or facilitates scheduling appointments and follow-up services; requests consultation and diagnostic reports from network specialists; contacts members to remind them about upcoming appointments and/or missed appointments.
Maintains and promotes confidentiality of patient information and adheres to all HIPAA regulations
Participates in monthly case studies in the Medical Services Department
Other duties as assigned.
- Experience in CM or other managed care environment.
- Knowledge of disease specific states, clinical and community resources.
- Strong critical thinking and problem solving skills.
- Ability to network, advocate, communicate assertively with all customers.
- Work involving high volume and strict timeframes.
- Excellent communication skills.
- Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus.
- Ability to work in fast paced environment.
- Works well independently as well as part of a team.
- Strong commitment to help others.
- Computer literate; must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus
- Minimum Education: LMSW or RN
- Licensure: Licensure must be current and unrestricted in the appropriate jurisdiction
- Preferred Education: BA or BS in Nursing, MSW in Social Work
- Minimum Experience:
- 2+ years of experience in a clinical acute care position, preferably in home health, physician’s office or public health
- Preferred Experience:
- 1 to 3 years disease management, case management or formal patient education experience;
- CCM Certification
- Licensure must be current and unrestricted in the appropriate jurisdiction
- Must be able to work in sitting position, use computer and answer telephone
- Ability to travel
- Office Work Environment
- Approximately 5% travel may be required
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.