We enjoy the important work we do every day on behalf of our members.
Job Summary
Under administrative and clinical direction from the Care Management Team Leader or designee, the Care Manager (CM) provides timely and clinically appropriate case management interventions to a geriatric population based on nationally recognized standards of case management practice and geriatric expertise. The CM will develop effective working relationships with members, families and providers in order to actively participate in the assessment of the member's needs and the development of individualized care plans, match the available health plan benefits and community services to those needs, coordinate the ongoing evaluation of the care plan, recommend and facilitate adjustments to the care plan and services in place, and focus on optimizing the member/family's level of independence in navigating the healthcare system at all levels of the continuum. This role is the corner stone of assuring the most appropriate services and resources are provided for our members. Experience in working with the elderly in the community and coordinating care is a plus, as well as experience and comfort with difficult life issues including end-of-life.
Job Description
KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS
The Care Manager assesses member's health care needs in order to collaborate with the member, their family, and providers to develop a quality and cost effective plan of care to improve, maintain or support optimal wellness within the context of the member's illness, medical condition and plan benefits.
Engages Specialty Team members as appropriate, collaborating with or referring to, Dementia Care, Pharmacy, Behavioral Health, Social Services or Palliative Care/Hospice.
Demonstrates accountability for member panel including assessing and documenting within department standard timeframes, coordinating care with provider partners, ensuring quality measures such as HEDIS are addressed, participating in medical group meetings as required, performing root cause analysis for cases with readmissions.
Participates in departmental staff meetings and/or other remote/on-site meetings as requested or required. Participates in Team quality improvement projects by identifying opportunities to enhance present workflows/policies and presenting information to support a potential outcome improvement.
Identifies, documents, and refers potential QA occurrences to the Clinical Quality Department for review.
The Care Manager provides support, coaching, and self-management education to assist members/caregivers in understanding health, wellness, disease, and symptom management.Advocates for the member's care and informational needs to support member/family independence, enabling them to make informed health care decisions and be active participants in a member-centric care plan.
The Care Manager integrates the use of decision-support software, medical policies, federal/state guidelines and treatment plan knowledge with Care Management department policies and procedures to ensure effective utilization of resources and achievement of optimal clinical outcomes.
Registered Nurse with current unrestricted Connecticut state license is required
CCM highly desirable
EXPERIENCE:
Minimum of five years of clinical nursing experience.
Experience in medical care management highly desirable
Experience in extended care planning highly desirable (discharge planning to Rehab, SNF, home care, hospice)
Experience using InterQual, Milliman, or similar decision-support software highly desirable
SKILL REQUIREMENTS:
Skill in conducting a comprehensive clinical and social geriatric assessment both telephonically and in-person
Skill in engaging providers for member/caregiver advocacy and appropriate resource utilization to promote best in class clinical outcomes
Skill in incorporating proven assessment, coaching techniques such as motivational interviewing, to promote health education to strengthen member/caregiver motivation and commitment to change behaviors to support health and wellness
Ability to develop a comprehensive member-centric care plan in collaboration with member and caregiver to ensure optimal health, wellness, and disease/chronic condition management, promoting self-management practices and improving symptom management
Understanding of geriatric condition management
Understanding of community resource referral process
Understanding of Level of Care and SNF, LTACH/AIR benefits
Understanding of member benefits and appeal process
Comfortable operating in a collaborative environment with matrixed departmental relationships
Knowledge of the state of Connecticut healthcare landscape
Able to work with minimal guidance and manage multiple priorities
Comfortable engaging other professionals including medical group leadership
Computer skills are required.Intermediate level understanding of Microsoft Office programs and remote working technology is a must, in addition to being facile in learning multiple other systems and programs and working within them daily
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS
Position is primarily home-office based in Connecticut with travel for meetings, conferences or educational classes to CarePartners of Connecticut offices, provider offices, facilities, member residences, or other locations
Fast paced office & onsite environments that require the balancing of multiple demands
Ability to carry supplies and or standard lap top computer with estimated weight of 15-30 pounds
Certain tests and immunizations may be required, depending on the specific requirements of the assignment
Occasional evening, early morning or weekend work may be required
A valid driver's license and access to an automobile for travel is required
Other projects/duties as assigned
Travel requirement may change appreciably based on corporate business needs, estimated 75% home and 25% travel
What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!
As of Nov. 1, 2021, full vaccination against COVID-19 is required to enter any Point32Health office or if, on behalf of Point32Health, you are meeting in-person with individuals outside of a Point32Health office. As of Dec. 8, 2021, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.