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Case Manager
Sanitas Nashville, TN
$79k-96k (estimate)
Other | Insurance 1 Month Ago
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Sanitas is Hiring a Case Manager Near Nashville, TN

Job Details

Level: Experienced
Job Location: Nashville - Antioch - Nashville, TN
Salary Range: Undisclosed
Job Category: Nursing

Description

Sanitas is a global healthcare organization expanding across United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.

Position Summary

Case Manger works with members, providers, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum.

The primary contact with the patient, family and other involved care providers will be by telephonically, all events will be documented in the electronic medical record (EMR).

Knowledge/Abilities.

Essential Job Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Conducts initial review of members data provided by health plan; to determine which HRA must be completed (Medicare Initial HRA and/or Annual HRA).
  • Compare against members self-reported data obtained through the Health Risk Assessment (HRA) process (if applicable).
  • Conducts comprehensive health risk assessment to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment per regulated timelines.
  • Interacts telephonically with member to initiate members individualized care plan using the available data based on HRA.
  • Prioritizes members according to intensity, need, and required follow-up mitigating immediate needs prior to visit with primary care provider.
  • Provide appropriate interventions which demonstrate knowledge of and sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served.
  • Assess the patients formal and informal support systems, including caregiver resources and involvement as well as available benefits and/or community resources.
  • Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns, avoiding duplication of services.
  • Facilitates comprehensive assessment summary for primary provider review and formulation of care plan.
  • Provide education, information, direction, and support related to care goals of patients.
  • Act as a patient advocate and assist with problem solving and addressing any barriers to care or compliance with care plan.
  • Maintain accurate patient records and patient confidentiality.
  • Measure outcomes and effectiveness of case management including clinical, quality of life and patient/family satisfaction.
  • Promote chronic disease management concepts, health screening and preventive health initiatives for targeted patients.
  • Facilitate disease prevention and health promotion with patients and family while promoting patient and family responsibility and self-management.
  • Troubleshoots problems regarding operational and clinical procedures that may affect patient outcomes.
  • Complies with all requirements of the Care Management Model of
  • Document all relevant information following department policy guidelines.
  • Maintain knowledge of operational procedures and case management program components.
  • Maintains knowledge of and compliance with current Medicare/Medicaid, state/federal rules.
  • Ensures compliance with the Medicare conditions of participation and other state regulations govern the provision of healthcare.
  • Complies with all Health Insurance Portability and Accountability Act (HIPAA) requirements in accordance with federal, state, and organizational policies.
  • Assumes responsibility for personal growth. Develops, maintains, and upgrades professional knowledge and practice skills through attendance at seminars, conferences and participation in continuing education and in-service classes.
  • Able to perform duties autonomously, schedule and meet workload expectations

Note for RN's: May have additional duties, such as providing consultation, recommendations and education as appropriate to non-RN case managers; working cases with members who have complex medical conditions and medication regimens; and/or conducting medication reconciliation when needed.

Qualifications


Required Education and Experience

  1. Completion of an accredited Registered Nurse (RN) or Licensed Practical Nurse (LPN) Program
  2. 1-3 years in case management, disease management, managed care or medical health settings
  3. 13-year experience working with Medicare population (preferred)
  4. Active, unrestricted State Nursing license (RN or LPN) license in good standing
  5. Active and unrestricted Certified Case Manager (CCM)

Knowledge, Skills and Abilities:

  • Knowledge and skill in chronic disease management
  • Excellent verbal and written communication (including documentation) skills
  • Excellent relationship management with patients, families, and care providers
  • Professional demeanor
  • Ability to work as a member of a team
  • Ability to organize and prioritize tasks
  • Ability to promote/participate in patient centered medical home mode of care
  • Exceptional customer service skills and understanding of patient and family centered care concepts
  • Strong organizational skills

Job Summary

JOB TYPE

Other

INDUSTRY

Insurance

SALARY

$79k-96k (estimate)

POST DATE

02/08/2023

EXPIRATION DATE

02/05/2024

WEBSITE

sanitas.com

HEADQUARTERS

AARAU, AARGAU

SIZE

200 - 500

FOUNDED

1958

TYPE

Private

REVENUE

<$5M

INDUSTRY

Insurance

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