Position Description:

The Case Manager provides telephonic outreach, disease and/or case management, education and support to plan members to support healthy lifestyle choices & to reduce long term effects of chronic illnesses. Performs other clinically based activities to coordinates care between the members, providers and community based health organizations.

Responsibilities:
• Provides telephonic outreach, disease management and/or case management, education and other clinically based activities to plan members.
• Conducts assessments, develops treatment plans and interventions and sets goals for treatment plans/behavioral modification within the scope of practice.
• Collaborates with member's medical/health and community based providers (including the PCP, HCH, certified dieticians, behavioral health specialists, or others as needed) regarding the member's treatment needs and plan of care.
• Collects clinical data and enters information into database for tracking and metrics purposes.
• Monitors and evaluates the services and community based resources necessary to respond to the individual member's health needs.
• Completes other special assignments and projects as assigned.

Education:
• Associates Degree in Nursing with current RN licensure required.
• BSN/MSN preferred.

Qualifications:
• Minimum 3 years clinical experience.
• Previous experience in a care management, quality improvement, medical record reviews, disease management and/or case management preferred.
• Professional certification (CCM, CCP) preferred.
• Knowledge of Medicare/Medicaid and community-based resources required.
• Knowledge of job specific medical specialty (disease management/chronic illnesses/maternity care).
• Knowledge of adult learning and behavior change principles preferred.
• Clinical assessment skills, consistent with state licensure scope of practice requirements required.
• Excellent written & verbal communication skills.
• Strong telephonic interviewing skills.
• Proficient in Microsoft Office, Internet/Web Navigation.
• Prioritization and organizational skills.
• Ability to assess patient health status, consistent with state licensure scope of practice requirements.
• Ability to integrate data and evaluate to design meaningful interventions.
• Must be able to prioritize and target interventions, consistent with state licensure scope of practice requirements designed to support long term behavioral change.