As a part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makers—hospitals, health systems, physicians, self-insured employers, and payers—to better connect every point of care and wellness management. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Conifer Health Solutions is currently hiring for an RN Case Management Specialist.
The Specialist Case Manager RN, under the direction of the Supervisor or Manager of Case Management provides direction, identifies health and psychosocial issues of a select member population and assesses, plans, implements, coordinates monitors and evaluates services and outcomes to ensure maximized health of the member. Assumes a leadership role within the interdisciplinary care team to achieve optimal clinical and resource outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
· Identifies issues relating to members' physical and mental wellbeing 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.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· 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
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
- 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 office or public health
- Preferred Experience:
- 1 to 3 years disease management, case management or formal patient education experience;
- CCM Certification
Include minimum certification required to perform the job.
· Licensure must be current and unrestricted in the appropriate jurisdiction
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· Must be able to work in sitting position, use computer and answer telephone
· Ability to travel
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· Office Work Environment
· Approximately 5% travel may be required
Conifer Value Based Care