Case Manager

POSITION SUMMARY:

As a Case Manager you will offer telephonic case management for members experiencing severe or chronic health conditions. We are actively recruiting for on-site Telephonic Case Managers who provide patient education, emotional support, and assistance with care coordination.

 

ESSENTIAL DUTIES and RESONSIBILITIES:

  • Coordinate care and services and develop patient treatment plans for catastrophic cases.
  • Telephonically manage cases on a long or short-term basis per established company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
  • Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
  • Develop treatment plan in collaboration with the patient, caregivers or family, community resources and multidisciplinary healthcare providers that include obtainable short and long term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
  • Initiate and maintain contact with the patient/family, provider, employer group, and multidisciplinary team as needed through the continuum of care.
  • Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
  • Meet daily productivity requirement.
  • Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
  • Perform data entry and maintain complete and detailed documentation of case managed patient in the computer system; maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.

 

EDUCATION/EXPERIENCE:

  • Current unrestricted RN, LVN license to practice in the state of California re –OR – degree in Social Work from an accredited college required.
  • 1+ years of case management experience required.
  • Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required.
  • Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred.
  • Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred.

 

COMPANY OVERVIEW:
With over 450,000 covered members and 400+ clients, HealthComp is the nation’s largest leading independent health plan administrator for self-funded employer groups. HealthComp has been dedicated to transforming benefits administration for over 25 years. Bringing together concierge-level service, operational excellence, powerful analytics and cost management, our solution that integrates seamlessly with any benefits ecosystem. HealthComp has offices in California, Illinois, West Virginia and Pennsylvania. For more information, visit HealthComp.com.

 

 

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