Value Based Case Management Analyst - LPN/LVN - Mississippi Gulf Coast
About The Position
At CareAllies , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Job Summary Under supervision this position is responsible for coordinating and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers in participating provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers.
Requirements
- Current Licensure as a licensed practical nurse or licensed vocational nurse, in the state of residence in good standing.
- Associates degree, diploma, or B.S. in Nursing preferred.
- Five (5) years of recent experience in an acute-care environment, or Two years (2) years recent experience in a case-management or utilization management position
Nice To Haves
- Bilingual (English/Spanish)
- Previous HEDIS and/or CMS STARs experience
- Strong proficiency level using Microsoft Excel
Responsibilities
- Coordinating and manage relationships with participating provider practices.
- Maintain detailed understanding of HEDIS / STAR performance measures.
- Develop and maintain a process to ensure all customers in participating provider practices meet all quality metrics.
- Coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources.
- Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
- Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers.
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- a minimum of 15 days’ of paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
- other incentives
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
101-250 employees
