JOB SUMMARY

The Specialist Case Manager RN, under the direction of the Supervisor or Manager of Case Management provides direction, identifies health and psychosocial issues of a select member population and assesses, plans, implements, coordinates monitor and evaluates services and outcomes to ensure maximized health of the member. Assumes a leadership role within the interdisciplinary care team to achieve optimal clinical and resource outcomes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Identifies issues relating to members' physical and mental well-being that affects health status and works in collaboration with both the member and provider to determine appropriate care for case management services.
• In collaboration with the member and PCP completes a comprehensive assessment and develops a care plan assessing short-term and long-term needs.
• Acts as a leader during interdisciplinary care team conferences to achieve optimal clinical and resource outcomes.
• Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
• Maintains and documents initial assessment; designs a care plan that is attainable and in the appropriate business application program.
• Acts as a liaison between physician and member to alleviate potential issues that can interrupt care
• Maintains case load by identifying cases that are no longer high in intensity or services and closes them timely and appropriately.
• Schedules or facilitates scheduling appointments and follow-up services; requests consultation and diagnostic reports from network specialists; contacts members to remind them about upcoming appointments and/or missed appointments.
• Maintains and promotes confidentiality of patient information and adheres to all HIPAA regulations
• Participates in monthly case studies in the Medical Services Department
• Other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Experience in CM or other managed care environment.
• Knowledge of disease specific states, clinical and community resources.
• Strong critical thinking and problem-solving skills.
• Ability to network, advocate, communicate assertively with all customers.
• Work involving high volume and strict timeframes.
• Excellent communication skills.
• Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus.
• Ability to work in fast paced environment.
• Works well independently as well as part of a team.
• Strong commitment to help others.
• Computer literate; must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Minimum Education: LMSW or RN
• Licensure: Licensure must be current and unrestricted in the appropriate jurisdiction
• Preferred Education: BA or BS in Nursing, MSW in Social Work
• Minimum Experience:
• 2 years of experience in a clinical acute care position, preferably in home health, physicians office or public health
• Preferred Experience:
• 1 to 3 years disease management, case management or formal patient education experience;
• CCM Certification

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• Licensure must be current and unrestricted in the appropriate jurisdiction

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment

TRAVEL

• Approximately 5% travel may be required

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $39.40-$59.09 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.