Care Management Specialist

We're Hiring: Care Management Specialist!

We are seeking a dedicated and compassionate Care Management Specialist to coordinate patient care services and ensure optimal health outcomes.

Location: Springfield, United States

Work Mode: On-site

Role: Care Management Specialist

Job Description

This position is responsible for discharge care coordination, episodic case management, and pre-admission/post-discharge counseling for an acute condition. This position is responsible for handling duties in an independent manner and may assist other staff. Establish relationship with the member through the immediate post-discharge follow-up period or until all short-term care needs are met. Provide education/local resource information and encourage member (self) education. Determine case complexity and refer to other internal departments as needed.

DUTIES AND RESPONSIBILITIES:'

• Coordinate discharge care, episodic case management, and pre/post-admission counseling; consult with physicians and planners to identify resources and reduce readmissions.
• Support member transitions by:
• Assessing and coordinating acute health needs with providers and members.
• Personalizing outreach based on risk and behavior.
• Monitoring medication adherence and safety.
• Reinforcing post-operative care instructions.
• Assisting with follow-up appointment barriers and scheduling.
• Helping find primary/specialist providers or Blue Distinction Centers.
• Providing transportation assistance when needed.
• Referring to community and home health resources.
• Offering face-to-face intervention when appropriate.
• Educating members to support behavior change and self-management.
• Collaborating on alternate care plans if necessary.
• Helping members and providers navigate the healthcare system.
• Assessing quality of care and referring cases to QA/QI as needed.
• Performing transition of care services across lines of business.
• Determining case complexity and referring to Case or Disease Management as needed.
• Practice within licensure scope.
• Serve as preceptor for new employee orientation.
• Maintain licensure and continue education through seminars and training.
• Communicate professionally with coworkers, management, and customers.
• Comply with HIPAA, diversity, corporate integrity, and compliance policies.
• Maintain confidentiality of company information.
• Keep management informed on developments and complete special projects as assigned.
  

Qualifications

• Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with current, active, unrestricted license in the state of operations (or reciprocity if applicable).
• 2 years clinical experience.
• 1 year health insurance/managed care experience. Knowledge of medical management policies and procedures.
• PC and database experience.
• Verbal and written communication skills.
• Customer service skills and interpersonal skills to discuss pre/post admission care with physicians, hospital staff and members.
• Ability and willingness to occasionally travel within assigned location. Possess transportation and current, valid driver's license for applicable state.
• Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by the client. Incumbents with other clinical licenses are not required to obtain multi-state licenses.
• LCPC, LCSW, Youth/DCFS experience preferred.