Full-Time Care Manager II – Clinical Complex Care
Job Description
Under the supervision of the Supervisor or Manager of Care Management, the Care Manager II is responsible for completing the appropriate level of care management activities for Colorado Access members. Specifically, this position will provide complex care coordination and case management for high acuity members and requires complex clinical decision making. Care management activities will include but will not be limited to completing assessments, determining eligibility, monitoring provider services, coordinating services, developing care plans, delivering care management interventions, appropriate follow up activities and completing all documentation in the expected time frame. The Care Manager II will apply appropriate criteria, guidelines, and regulations specific to the level of care and services required to meet the member/family goals and the organizational/contractual requirements. Care management functions may be performed for members in a variety of settings including telephonic, in-person or in the community setting.
REQUIREMENTS:
Education: Bachelors Degree in Nursing required.
Experience: Three years of clinical, care management and/or healthcare experience required. Experience working with Medicare and Medicaid populations, and related social/economic issues delivering care management services, conducting assessments, interviewing members, developing service plans, coordinating care and monitoring services for members preferred.
Knowledge, Skills, and Abilities: Knowledge of managed care, care management and utilization management is required. Ability to process high volume of work efficiently with a high level of customer service detail. Knowledge of and ability to relate to populations served by the programs for which we work, client interviewing and assessment skills, knowledge of policies and procedures regarding public assistance programs, ability to develop care plans and service agreements, knowledge of resources, and negotiation, intervention, and interpersonal communication skills. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills, strong organizational and time management skills, strong interpersonal skills and the ability to handle multiple priorities. Position requires flexibility to use complex processes and procedures to facilitate quality outcomes and/or resolutions while working with other team members with varied skills and educational background. Ability to work independently outside of office setting and conducting face to face assessment visits. Must have general computer skills and ability to work with Microsoft Office products. Requires the ability to use the complaint, grievance and appeals process and procedures to facilitate quality outcomes and/or resolutions for members. May be required to manage multiple priorities and projects with tight deadlines.
Licenses/Certifications: If licensed, a current unrestricted Colorado license as a healthcare professional RN. A valid driver’s license and proof of current auto insurance will be required for any position requiring driving.
*Due to the pandemic, our employees are temporarily working at home. We require our workforce to reside in Colorado and telecommute, which may require you to come into the office as we serve our local communities.
How to Apply
to view the full job description, requirements and compensation, please go to https://us60.dayforcehcm.com/CandidatePortal/en-US/coaccess/Posting/View/299 and apply directly there.407 total views, 0 today