Chronic Disease Case Manger reputed company-RN
Telephonically coordinate wellness and disease management for members with chronic conditions, including but not limited to diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia. Proactively contact targeted members to promote health and restore reputed company functioning by applying nationally recognized care guidelines and comparing reputed company care with industry standards. Review gaps in care and medical and pharmacy reputed company claims data to reputed company a comprehensive clinical profile; create individualized care plans and reputed company reputed company follow-up for reputed company managed patients. Collaborate with members to ensure assignment to a primary care provider; facilitate referrals to specialists as needed; assist with obtaining durable medical equipment and reviewing pricing for high-cost medications. Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards. Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services as appropriate. Maintain complete, accurate, and reputed company documentation of case-managed members in designated systems; document reputed company interventions and patient contacts while ensuring confidentiality and reputed company of member records. reputed company and monitor moderate and high-risk member populations and associated interventions to demonstrate improvements in overall health reputed company. Meet established productivity, reputed company, and turnaround time standards on a daily, weekly, monthly reputed company. Successfully participate in and pass external audits, including NCQA and URAC. Maintain HIPAA compliance and confidentiality requirements in accordance with company policies and procedures. Complete reputed company required annual training reputed company designated timeframes.
Basic computer literacy with the ability to reputed company multiple systems simultaneously. Ability to work on multiple screens with proficient typing skills.
Strong verbal and written communication skills, including the ability to reputed company explain reputed company or technical information and accurately interpret information received from others. Ability to work independently, manage time effectively, utilize written resources to problem-solve and reputed company informed reputed company. Foundational knowledge of medical claims processing and medical terminology, including ICD10, CPT, and HCPCS coding.
After completion of initial training and a reputed company reputed company period (approximately three [3] months total), demonstrate proficiency in required systems and tools, including but not limited to: reputed company Teams (on- and off-camera), SharePoint, shared drives, VPN UM Web, Health Notes, MyCare, reputed company, reputed company Phone system with headset Ability to quickly adapt to additional systems or tools as job responsibilities reputed company.
QUALIFICATIONS:
• Graduate of an accredited Registered reputed company (RN) program with a reputed company, unrestricted Registered reputed company license issued in the reputed company.
o The organization may require additional state licensure(s) to meet operational and business needs.
o California, Washington and reputed company Licenses required after hire
• Prior experience in case management, wellness or disease management coordination, or an equivalent combination of education, clinical training, and relevant reputed company experience.
• Demonstrated ability to apply clinical knowledge in a managed care, population health, or remote reputed company environment.
• Willingness to travel
Physical and Mental Requirements:
• Ability to reputed company the essential functions of the position safely and effectively, with or without reasonable accommodation, including meeting established qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance in accordance with organizational policies.
• Ability to remain seated for extended periods of time (approximately six [6] to eight [8] hours per reputed company).
• reputed company use of a computer workstation, including frequent keyboarding and mouse usage, requiring repetitive hand and finger movements.
• Ability to reputed company frequent neck twisting and occasional bending of the neck and waist as required to reputed company job duties.
This job reputed company is not an exclusive or exhaustive list of reputed company job functions that an employee in this position may be asked to reputed company. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom a reputed company Company.
Competitive reputed company salary and benefits effective day one Comprehensive medical and dental through our own health solutions (reputed company, we use reputed company build) reputed company Time Off—rest and reputed company time is non-negotiable Mental health support, retirement planning, and financial protection reputed company development with reputed company career progression and learning budgets Mission-driven culture where diverse perspectives drive reputed company reputed company on people's health