Job Description

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.


Equal Opportunity Employer Minorities/Women/Veterans/Disable


The Medical Case Manager manages and tracks all members who require a comprehensive approach to immediate and ongoing care of their complicated and/or catastrophic illnesses. This position provides members with ongoing case management services due to their chronic and at times debilitating conditions. The Medical Case Manager documents interactions with and on behalf of the member throughout service delivery including, but not limited to: care plans, progress notes, assessments, correspondence, and authorizations.

Job Responsibilities:
Provide Case Management services to referred members:
* Act as a liaison to facilities, providers and/or members related to issues in case management and care services
* Identify member needs and address these needs to remove any barriers in achieving optimal health and medical care
* Educate members on the importance of good health and following up with the Primary Care Physician on a regular basis
* Review prior authorization/service requests with Medical Director for determination
* Complete member surveys, assessments and care plans
* Request and review medical records
* Provide and coordinate community resources and referrals
* Provide member education on disease processes
* Collaborate with the Interdisciplinary Team to incorporate best practices, assess outcomes and develop individualized care plans
* Develop and monitor the member’s care plan goals for progress and outcomes
* Accurately document members’ case management plans, authorizations, assessment, and levels of care
* Attend case management team meetings, as scheduled

Conduct Health Risk Assessments on all newly enrolled members and those members who are eligible for a re-annual assessment:
* Identify members who are in need of a Health Risk Assessment through the Health Risk Assessment Report
* Complete the Health Risk Assessment in the medical management software system
* Assess member’s medical, social, environmental and functional needs and address any immediate identified needs with the member’s medical team
* If a member is in need of ongoing case/disease management services open a case management program and/or assign to the appropriate case manager to meet the member’s needs
* Provide a copy of the Health Risk Assessment to the member’s outpatient clinical team
* Monitor progress towards treatment goals

Assist with any other job duties identified by the department:
* Assist with any reporting/tracking responsibilities
* Assist other departments when necessary to ensure the member’s health care needs are met

Qualifications

Professional Competencies (knowledge, skills, and abilities):

Knowledge:
Knowledge of Medicare and Medicaid regulations and guidelines preferred
Knowledge of professional and community based resources helpful
Experience coordinating patient care
Knowledge of medical terminology
Previous Case Management experience preferred

Skills:
Computer experience necessary
Effective time management skills
Effective interpersonal and communication skills

Abilities:
Ability to use electronic medical record and claims systems
Problem solving abilities
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Work respectfully and positively with members and providers
Ability to handle multiple tasks and prioritize work tasks to adhere to deadlines and identified time frames
Ability to think analytically and make decisions
Handle multiple and changing priorities at a fast pace

Education:
Associate’s degree or Bachelor’s degree from an accredited Nursing School
 
Experience:
At least two (2) years experience in a health care setting working as a Case Manager
HMO/Managed Care/ Medicare/Medicaid experience preferred

Certification and License:
Active, current, valid, unrestricted Arizona State Registered Nurse (RN) License or LPN license , as applicable

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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