Senior Risk Adjustment Coder – Government Programs
Capital Blue Cross
Nurse Case Manager, RN
Sage Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- Implementing and reviewing healthcare plans for geriatric patients, those recovering from serious injuries, or dealing with chronic illnesses
- Collaborate with doctors and other medical professionals to provide comprehensive care
- Advocate for patients and coordinate their care across settings
- Create and manage plan of care for chronic or serious conditions (diabetes, heart disease, CHF, cancer, etc.)
- Schedule and follow up on hospital post-discharge appointments within 72 hours
- Communicate with patients and families about health conditions and care plans
- Offer education and guidance in collaboration with primary care physicians for complex medical decisions
- Serve as a liaison between patients and insurance providers to promote quality, cost-effective care
- Verify daily Sage Health patient hospital census and planned discharges
- Identify and provide resources and information to assist patients and family members (in collaboration with CMO/designee)
- Hold regular meetings and communications with clinical support staff, physicians, and operations leadership
- Assist primary care physicians in executing virtual appointments in patients' homes
- Ensure overall quality of healthcare and update electronic health records with recent treatments
- Maintain readiness for health plan audits, and local, state, and federal inspections
- Stay up to date on nursing regulations and support the clinical staff
- Perform other duties as assigned
Requirements
- B.S. Degree in Nursing
- Valid and active Registered Nurse license in the state of employment
- Certification in Basic Life Support (BLS)
- 2-3 years' experience working in an inpatient, outpatient i.e., Home Health, Hospice, or health plan case management (minimum 24 months)
- Strong knowledge of clinical assessment skills and experience with chronic disease management
- Experience working in medically underserved/culturally diverse communities
- Excellent interpersonal, written, and verbal communication skills
- Must be organized and attentive to detail
- Ability to manage competing priorities
- Ability to work in a fast-paced environment
- Resourcefulness in problem solving
- Able to take and follow through with assigned tasks and accountability
- Valid driver's license, car insurance, and access to an automobile
- Must be able to travel between multiple healthcare facilities i.e., centers, hospitals, skilled nursing facilities, and patient homes
- Experience working with an electronic health record
- Must be skilled in web navigation and use of mobile hotspots
- Experience with Microsoft Office Word, Outlook, and Excel
- Full COVID-19 vaccination (including boosters); candidates in states that mandate boosters must comply
- Preferred: Certification in Case Management (ACM or CCM), CCM, Managed care experience (Medicare HMO, D-SNP), Motivational interviewing, Bilingual Spanish and English
