Unit Secretary / Nursing Tech
Presbyterian Healthcare Services
Complex Case Manager, RN – Maternity/NICU
Highmark Health
full-time
Posted on:
Origin: • 🇺🇸 United States • New York, Pennsylvania, Virginia, West Virginia
Visit company websiteSalary
💰 $57,700 - $107,800 per year
Job Level
SeniorLead
About the role
- Maintain oversight over a specified panel of members by performing ongoing assessment of members’ health management needs and identifying right clinical interventions
- Manage active case load of members enrolled in case management, including outreach and care coordination
- Create care plans for assigned case load addressing identified needs, removing barriers, identifying resources, and scheduling regular re-assessment contacts
- Encourage behavior changes, help members coordinate care, and identify resources to assist members in achieving health goals
- Utilize data/analytics combined with clinical judgment to identify appropriate clinical interventions and triage to multi-disciplinary resources
- Refer members to appropriate multi-disciplinary resources and work supported by multi-disciplinary team
- Monitor, improve and maintain clinical, financial and functional quality outcomes for the specified panel of members
- Ensure documentation and activities comply with business process, regulatory requirements and accreditation standards
- Maintain current knowledge and adhere to applicable CMS, state, local, and regulatory agency requirements and standards of practice for case management
- Perform other duties as assigned or requested
Requirements
- High School Diploma/GED required
- Preferred: Bachelor's Degree in Nursing
- Required: 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and/or health insurance experience (84 months)
- Preferred: Maternity Case Management experience
- Preferred: NICU Case Management experience
- Preferred: Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
- Required: RN license in PA or WV or DE or NY (other RN license(s) must be obtained within first 6 months if applicable)
- Preferred: Certification in Case Management
- Proficiency in MS Excel and strong analytic skills
- Broad knowledge of disease processes and healthcare service delivery system
- Written and verbal presentation skills, negotiation skills, and ability to positively influence others
- Excellent interpersonal/consensus building skills and ability to work with internal/external colleagues at all levels
- Ability to work in a high performing team environment, handle multiple priorities, strong organizational/time/project management skills
- Self-directed; ability to work successfully with indirect supervision and moderate autonomy
- Language requirement: None
- Travel requirement: 0% - 25%
