Chronic Condition Case Manager / RN

MedWatch • FL

95d • $62,000 - $74,000

About The Position

The Chronic Condition Case Manager will have direct responsibility for managing an individual caseload using Complex and Chronic Condition Management constructs. This individual is expected to accurately service and satisfy customers by responding to customer inquiries, communicate benefit and healthcare questions/answers.

Requirements

• Minimum of three years of clinical experience including at least two years of chronic disease management and patient teaching.
• Registered Nurse (current unrestricted, in state of practice).
• Good keyboarding skills and computer literacy, preferably with Microsoft Office applications.
• Fluency in English.
• Good organizational skills and time management.
• Excellent verbal and written communication skills.
• Ability to handle difficult situations tactfully and diplomatically.
• Effective problem solving and decision-making skills.
• Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint).

Responsibilities

• Practice within the scope of licensure.
• Collect and document patient information to facilitate the initial assessment and formulation of an initial plan of care.
• Continuously gather, update and review information including medical records, history, and assessment information.
• Guide, coach and encourage the patient in following the plan of care.
• Instruct the participant regarding both short and long-term goals and offer guidance on how to meet those goals.
• Document actions taken and interventions provided throughout the process.
• Collaborate with providers, payers, and participants to ensure access to appropriate resources.
• Contact the payer to determine benefits and constraints impacting the plan of care.
• Contact providers and vendors to verify medical necessity of care or products ordered.
• Make arrangements for quality care according to participant needs, physician’s orders, and available benefits.
• Maintain a current working knowledge of alternative treatments.
• Provide cost-benefit analysis for extra-contractual services when necessary.
• Become familiar with community resources or other funding sources for quality care.
• Maintain documentation in the computer system and complete all aspects of the case.
• Prepare timely reports to the payer for fee-for-service clients.
• Maintain billing as appropriate in the computer system.
• Adhere to standards of production goals.
• Maintain ongoing contact with providers and participants.
• Negotiate with providers to maximize medical benefits available to the participant.
• Take actions upon awareness of non-medical issues affecting participant safety or welfare.
• Consult with the Director of Case Management regularly.
• Use good organizational skills to manage time and resources efficiently.
• Use effective writing style to organize information and present it clearly.
• Use effective teaching strategies during contacts with patients.
• Seek opportunities for personal growth and development.
• Maintain a professional attitude and approach.
• Adhere to all department and company policies and procedures.
• Participate in onsite and offsite employee health fairs as needed.
• Participate in the Quality Management Program.

Benefits

• E.O.E.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees