Integrated Care Manager
ZING. Enamel Whitening. Toothpaste, but magic.
full-time
Posted on:
Location Type: Remote
Location: Illinois • United States
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Salary
💰 $80,000 - $92,000 per year
About the role
- Conducting health risk assessments, coordination of care, and care management for MAPD, C-SNP, and D-SNP members.
- Performs assessments of members, including Health Risk assessments per CMS regulation
- Follows the patient through various transitions of care to ensure that any gaps in treatment plans are identified and remedied, and promote efficient health care delivery.
- Participates in assessment activities to develop individualized care plans in coordination with the patient, family, and providers.
- Applies case management standards of practice to focus on effective care of high-need members.
- Serves as a member advocate and resource, and provides critical information and recommendations to the rest of the care team.
- Maintains strong knowledge of Case management, community resources, and plan benefits to promote improved member experience and health outcomes.
- Works collaboratively with the member (and caregivers), primary care physicians, specialists, and other care providers to ensure member compliance and adherence to the medical plan of care.
- Assists the Health Services Team in implementing best practices for chronic care and disease management.
- Follows standard protocols, processes, and policies.
- Provides member education to assist with self-management and encourages members to make healthy lifestyle changes.
- Makes referrals to outside sources.
- Documents and tracks clinical reviews, member care plans, referrals, and findings.
- Performs other duties, projects, and actions as assigned.
Requirements
- Registered Nurse (RN) with 3 years of direct clinical care to the consumer in a clinical setting.
- Current, valid, unrestricted license
- 3 years of managed care experience or other commensurate experience
- Demonstrates strong clinical knowledge, ability to perform clinical assessments, ability to use critical thinking skills and has the capacity for continued learning.
- Knowledge of plan benefit designs.
- Demonstrated ability to perform case management & disease management activities.
- Problem-solving skills: the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
- PC proficiency to include Outlook, Word, Excel, database experience, and web-based applications.
- Personal management skills — Plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments.
- Teamwork — ability to work well with one or more groups.
- Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization.
- CM or DM experience with a Managed Care Organization (MCO)
- Patient education experience.
- Bilingual – English and Spanish
- Certification in Case Management or a nationally recognized health care certification.
Benefits
- Medical, Dental, and Vision
- Employer-Paid Life Insurance
- Paid Maternal Leave
- Paid Paternal Leave
- 401(K) match up to 4%
- Paid-Time-Off
- Employee Assistance Programs
- Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical assessmentscase managementdisease managementhealth risk assessmentsmanaged care experienceplan benefit designscritical thinking skillspatient education
Soft Skills
problem-solving skillspersonal management skillsteamworkinterpersonal effectiveness
Certifications
Registered Nurse (RN)Certification in Case Management