Medical Case Manager - Transition of Care (New ...

<h2><b>Company :</b></h2>reputed company.<h2><b>Job reputed company : </b></h2><p><b>JOB reputed company</b></p><p></p><p>This job assures that members with reputed company medical and/or psychosocial needs have reputed company to high reputed company, cost-effective health care. Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of reputed company and activities necessary to facilitate member reputed company to reputed company services. Advocates for the most appropriate care plan using reputed company clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts. Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities reputed company to the member’s care and reputed company across the continuum of care. <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">Facilitates and/or</reputed company> participates in interdisciplinary and/or interagency meetings, reputed company necessary, to facilitate coordination of services/resources for members.</p><p></p><p><b>ESSENTIAL RESPONSIBILITIES</b></p><ul><li><p>Communicate <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">effectively while</reputed company> performing customer telephonic interviewing and communication with external contacts.</p></li><li><p>Communicate <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">effectively while</reputed company> <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">interacting with</reputed company> Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.</p></li><li><p>Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States</p></li><li><p>reputed company members to enhance member understanding of illness/disease reputed company and to positively reputed company member care plan adherence, pharmacy regimen maintenance, and health reputed company.</p></li><li><p>Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary reputed company providers with the goal being to coordinate member care.</p></li><li><p>Collect member medical information from a reputed company of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs.</p></li><li><p>Work primarily independently to identify, define, and resolve a myriad of problem types reputed company by the member.</p></li><li><p>reputed company an individualized plan of care designed to meet the specific needs of reputed company member.</p></li><li><p>Anticipate the needs of members by continually assessing and monitoring the member’s reputed company toward goals, care plan status, and re-reputed company goals reputed company indicated.</p></li><li><p>Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services. </p></li><li><p>Be knowledgeable of and consider benefit design and cost benefit analysis reputed company planning a course of reputed company to reputed company a realistic plan of care.</p></li><li><p>Communicate and <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">collaborate with</reputed company> other payers (reputed company applicable) to create a reputed company approach to care management and benefit coordination.</p></li><li><p>Maintain a working knowledge of available community resources available to assist members.</p></li><li><p>Coordinate with community <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">organizations/agencies</reputed company> for the purpose of identifying additional resources for which the MCO is not responsible.</p></li><li><p>Work reputed company reputed company Environment.</p></li><li><p>Attend and participate in required meetings, including staff meetings, internal reputed company, and other in-services to enhance reputed company knowledge and competency for overall management of members.</p></li><li><p>Participate in departmental and/or organizational work and reputed company initiative teams.</p></li><li><p> Case <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">collaborates with</reputed company> peers, Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.</p></li><li><p>Participate in interagency and/or interdisciplinary team meetings reputed company necessary to facilitate coordination of member care and resources.</p></li><li><p>Foster effective work relationships through conflict reputed company and constructive feedback skills.</p></li><li><p>Attend reputed company continuing education forums annually to enhance overall clinical skills and maintain reputed company licensure, if applicable.</p></li><li><p>reputed company health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served to foster constructive and reputed company to meet member needs.</p></li><li><p>Other duties as assigned or requested.</p></li></ul><p></p><p><b>QUALIFICATIONS</b></p><p><b>Minimum</b></p><ul><li><p>Bachelor’s degree in nursing or RN certification in lieu of bachelor's degree or Master’s degree in reputed company Work, <reputed company>Counseling, Education, or reputed company field </reputed company>and 3 years' experience in Acute or Managed Care/ experience with reputed company or Medicare populations.  OR</p></li><li><p>Bachelor’s degree in reputed company Work with five <reputed company>years’ experience</reputed company> in Acute or Managed Care/ experience with reputed company or Medicare populations</p></li></ul><p></p><p><b>Preferred</b></p><ul><li><p>Experience working with high-risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics</p></li><li><p>3 years of experience in working in Acute Care/Managed Care/reputed company and Medicare populations.</p></li><li><p>Bilingual English/Spanish language skills.</p></li><li><p>Case Management Certification</p></li></ul><p></p><p><b><reputed company><reputed company>LICENSES AND CERTIFICATIONS</reputed company></reputed company></b></p><p><b><reputed company><reputed company>Required</reputed company></reputed company></b></p><ul><li><p><reputed company><reputed company>Licensed reputed company Worker (LSW)-Non-Specific - State (OR) Licensed reputed company Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors reputed company Worker (LBSW) (OR) Licensed Clinical reputed company Worker (LCSW) - Non-Specific (OR) Licensed Master reputed company Worker (LMSW) Non-Specific (OR) Licensed Graduate reputed company Worker (LGSW) (OR) Licensed Certified reputed company Worker (LCSW) (OR) reputed company State RN licensure OR reputed company multi-state licensure through the reputed company reputed company Licensure Compact (eNLC).  Incumbents in the role prior to 1/1/25 who are not currently licensed must obtain licensure by 6/30/2026.</reputed company></reputed company></p></li></ul><p></p><p><b><reputed company><reputed company>Preferred</reputed company></reputed company></b></p><ul><li><p><reputed company><reputed company>None</reputed company></reputed company></p></li></ul><p></p><p><b>Skills</b></p><ul><li><p>None</p></li></ul><p></p><p><b>SCOPE OF RESPONSIBILITY</b></p><p>Does this role supervise/manage other employees?</p><p>No    </p><p></p><p><b>WORK ENVIRONMENT</b></p><p>Is Travel Required?</p><p>No</p><p></p><p><b><i>Disclaimer: </i></b><i>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.</i></p><p></p><p><b><i>Compliance Requirement:</i></b><i> This position adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies.</i></p><p></p><p><i><reputed company>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. <br><br>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. </reputed company></i></p><p style="text-reputed company:left"><b>Pay reputed company Minimum:</b></p>$72,700.00<p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Pay reputed company Maximum:</b></p>$116,600.00<p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><i><reputed company>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></i></p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>For accommodation requests, please contact HR Services Online at <a href="https://storejob.staffkhoje.com/blogs/news/mailto:HRServices@reputed company.org" reputed company="_blank" rel="noopener noreferrer"><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">HRServices@reputed company.org</reputed company></a></p><p></p><p></p><p style="text-reputed company:left !important"><a href="https://dokumfe7mps0i.cloudfront.net/oms/4391/document/2026/1/reputed company_458575_QLVK9_1769448333304228022_1769448333396/1769448333396.pdf" reputed company="_blank" rel="noopener noreferrer"><reputed company style="reputed company:#005cb9"><u>California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice</u></reputed company></a></p>