Job Description

MUST LIVE IN CENTRAL MARYLAND

Summary/Position Objectives: 

This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high risk and special needs members.

Responsibilities: 

Essential Functions:

• Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
• Serves as interdisciplinary team member in management of identified members, performing clinical/social determinant of health assessments and in collaboration with physicians, determining medical needs.
• Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management.
• Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
• Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs.
• Utilizes clinical judgment to discharge members from care management according to plan policies and procedures.
• Maintains care management record according to plan policies and procedures and ensures data integrity in health plan information systems.
• Collects, evaluates, and reports clinical, functional and program activity as applicable.
• Identifies cases to assess for impact of care management services, may assist in the collection of data.
• Educates members’ medical providers regarding the members’ special needs to ensure consideration is given to the unique needs of the patients in treatment planning.
• Coordinates and communicates with community support and social service systems for members.
• Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
• Collaborate with multidisciplinary teams to facilitate member care and reduce care management barriers.
• Assists with the development of policies and procedures related to care management.
• Communicates effectively with supervisor/manager with regard to departmental issues, member issues, program status, compliance issues, etc.

Secondary Functions:

• Assists with special projects to meet plan and departmental goals.
• Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures.
• Demonstrates an understanding of the functions of other departments communicates with other departments appropriately and maintains positive working relationship.
• Identifies and reports gaps in the service delivery system.
• Performs other duties and special projects as assigned.
• Maintains a high level of professionalism at all times.
• Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
• Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
• Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.

• Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs, if required.

Knowledge and Skills:

• The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.
• Ability to perform mathematical skills and simple stats accurately.
• Demonstrated written and verbal communication skills.
• Ability to conduct presentations and training before small and large groups.
• Knowledge of the American with Disabilities Act of 1990.
• Demonstrated skill in written and oral communication to include presentations and training before small and large groups.
• Strong problem solving, organizational and time management skills with the ability to consistently work in a fast-paced environment.
• Ability to type 45 words per minute.

Education and Work Experience:

• Registered Nurse with current state license. Must have experience helping members using community agencies.
• 2 years managed care experience preferred
• Registered Nurse with BSN preferred.

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 80,000 - 100,000.

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