Care Management Analyst CMO

Montefiore Health System•Norfolk, VA

6d•$64,000 - $80,000•Onsite

About The Position

Working under the supervision of a licensed/certified clinical professional, the Care Management Analyst (CMA) supports care management programs serving pediatric and adult populations with complex medical, behavioral health, chronic care, palliative care, care transition, and social determinants of health needs. This highly collaborative role combines patient engagement, care coordination, population health management, and utilization management to help patients navigate the healthcare system, overcome barriers to care, and achieve optimal health outcomes. The CMA plays a key role in advancing patient-centered, whole-person care across the continuum of care. Through the collection and integration of clinical, behavioral, psychosocial, and utilization information from patients, caregivers, providers, electronic health records, and other clinical information systems, the CMA develops a comprehensive understanding of patient needs and identifies opportunities for intervention. Working closely with care managers, physicians, interdisciplinary care teams, and community partners, the CMA facilitates access to healthcare services and community-based resources, supports implementation of individualized care plans, promotes treatment adherence and self-management, and monitors ongoing care management interventions to improve quality, outcomes, and patient experience. The CMA is responsible for managing a designated caseload and supporting care management and utilization management activities designed to reduce avoidable emergency department visits, hospital admissions and readmissions, improve care coordination and access, address social and clinical barriers to health, and enhance member engagement and satisfaction. Through proactive outreach, data-driven interventions, and timely follow-up, the CMA contributes to improved health outcomes and value-based care performance.

Requirements

High School Diploma or GED required.
LPN (Licensed Practical Nurse, with valid NYS registration)
2 Years work experience
Experience working within case/utilization management systems, data entry and typing
MS Office, email, internet
Automatic phone distribution systems
Electronic fax systems
Copier/scanning machine
Familiarity with web-based information systems

Nice To Haves

Medical Management experience in a managed health care setting preferred.
Appropriate training and experience in case management preferred.

Responsibilities

Supports care management programs serving pediatric and adult populations with complex medical, behavioral health, chronic care, palliative care, care transition, and social determinants of health needs.
Combines patient engagement, care coordination, population health management, and utilization management to help patients navigate the healthcare system, overcome barriers to care, and achieve optimal health outcomes.
Collects and integrates clinical, behavioral, psychosocial, and utilization information from patients, caregivers, providers, electronic health records, and other clinical information systems.
Develops a comprehensive understanding of patient needs and identifies opportunities for intervention.
Facilitates access to healthcare services and community-based resources.
Supports implementation of individualized care plans.
Promotes treatment adherence and self-management.
Monitors ongoing care management interventions to improve quality, outcomes, and patient experience.
Manages a designated caseload.
Supports care management and utilization management activities designed to reduce avoidable emergency department visits, hospital admissions and readmissions, improve care coordination and access, address social and clinical barriers to health, and enhance member engagement and satisfaction.
Contributes to improved health outcomes and value-based care performance through proactive outreach, data-driven interventions, and timely follow-up.