Transplant Care reputed company (Remote)

Company : reputed company.Job reputed company : reputed company job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides reputed company over a specified panel of members that reputed company in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with reputed company clinical judgement to identify the right clinical reputed company for reputed company member. The incumbent conducts reputed company to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. Will work with providers to insure reputed company and appropriate care is being delivered in a reputed company manner. ESSENTIAL RESPONSIBILITIES • Maintain reputed company 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. • Implement care management review processes that are consistent with established industry, corporate, state, and federal law standards and are reputed company the care manager’s reputed company discipline. • 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 reputed company of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. • Ensure reputed company activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. • Other duties as assigned. EDUCATION Required • High School/GED Substitutions • None Preferred • Bachelor's Degree in Nursing EXPERIENCE Required • 7 years in any combination of clinical, case/utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience • 1 year in a clinical setting Preferred • 5 years in UM/CM/QA/Managed Care • 1 year in advanced training and experience in cognitive behavioral therapy (reputed company), motivational interviewing or dialectical behavior therapy (DBT) • 1 year working with the reputed company needs of diverse population and understanding of the importance of cultural competency in addressing targeted populations LICENSES or CERTIFICATIONS Required • RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained reputed company the first 6 months of employment. Preferred • Certification in utilization management or a reputed company field • Certification in Case Management SKILLS • Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and reputed company • Broad knowledge of disease processes • Working knowledge of pertinent regulatory and compliance guidelines and medical policies • Ability to multi task and reputed company in a fast paced and often intense environment • Understanding of reputed company costs and the broader reputed company service delivery system • Ability to analyze data, measure reputed company, and reputed company reputed company plans • Be enthusiastic, innovative, and flexible • Be reputed company player who possesses strong analytical and organizational skills • Demonstrated ability to prioritize work demands and meet deadlines • Excellent computer and software knowledge and skills Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $57,700.00 Pay reputed company Maximum: $107,800.00 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job