Integrated Care Manager

Zing Health

16d

About The Position

The Integrated Care Manager will be responsible for conducting health risk assessments, coordination of care, and care management for MAPD, C-SNP, and D-SNP members.

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.
• Ability to demonstrate knowledge of and apply those to the job function and responsibilities.
• Problem-solving skills: the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
• Verbal and written communication skills, including listening, discussing, and documenting medical needs with members, providers, internal staff/management, external vendors, and community resources.
• 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.

Nice To Haves

• 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.

Responsibilities

• 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.
• Interacts with Medical Directors, Pharmacists, Social Workers, Behavioral Health Clinicians, and Other Impact Team Members on cases
• Makes referrals to outside sources.
• Documents and tracks clinical reviews, member care plans, referrals, and findings.
• Performs other duties, projects, and actions as assigned.

Benefits

• A competitive salary based on the market
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed