Case Manager, Complex

Johns Hopkins•Hanover, MD

4d•$40 - $62•Remote

About The Position

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here. What awaits you: Work-life balance - This is a remote role. Medical, Dental, and Vision Insurance. 403B Savings Plan w/employer contribution. Generous Paid Time Off Employee and Dependent Tuition assistance benefits. Health and wellness programs and MORE! Who you are: The Case Manager anticipates and coordinates care / services / health education for targeted patient populations with chronic disease conditions or high cost specialty care. She/he demonstrates knowledge of case and disease management, prognosis and outcomes, and is responsible for ensuring that patient goals are achieved within a specified time period based upon individual needs, reasonable expectations and well-documented outcomes.

Requirements

Demonstrated clinical expertise in acute care nursing with clinical expertise in a specialty area preferred.
Knowledge of health care and managed care delivery systems.
Standards of medical practice.
Insurance benefit structures and related legal/ medical issues.
Utilization management and quality improvement processes.
Community resources.
Ability to work in a dynamic, team-oriented environment and demonstrate positive relationship building.
Effective verbal/ written communication.
Ability to affect change.
Ability to perform critical analysis, plan and organize effectively.
Ability to promote patient/family autonomy.
Business acumen so that health benefits and patient/provider satisfaction are maximized while solidifying the program's viability through cost effective intervention.
Minimum five (5) years clinical practice.
Minimum three (3) years clinical practice in a specific specialty.
Current registered nurse licensure in the state of Maryland or LCSW-C.

Nice To Haves

Additional case management/ disease management or managed care experience preferred.
Certification in case management (CCM) preferred.
Bachelor's degree in nursing or related years of experience, or MSW in social work preferred.

Responsibilities

Identifies and acts upon impending changes in patient condition.
Identifies and analyzes staff/patient/system issues that impact the plan of care.
Initiates corrective action.
Reviews/interprets patient population specific financial reports.
Maintains budgeted caseload
Makes decisions regarding work processes based on established guidelines.
Understands and uses principles of negotiation.
Effectively uses resources within control.
May assign work to support staff