Company Overview
We are a data-driven healthcare organization focused on operational excellence. Our mission is to provide affordable quality healthcare, improve patient health, and support healthcare providers. We utilize AI and predictive analytics to strengthen connections between patients and healthcare providers through our embedded Healthguides™ and centralized Managed Service Organization. Our physician-led approach allows our partners to deliver high-quality healthcare with an emphasis on positive outcomes and value for patients.
Role Overview
In this role, you will work collaboratively with clinical teams to deliver comprehensive case management and enhance relationships between patients and their primary care physicians. You will assist patients in reaching their highest level of wellness by addressing complex medical conditions, socio-economic factors, and mental health issues. Your responsibilities will include assessing, planning, implementing, coordinating, monitoring, and evaluating available services to optimize health outcomes for patients. You will collaborate closely with other care team members, including approximately five patient care navigators.
Key Responsibilities
- Conduct comprehensive assessments of healthcare and psychosocial needs of patients.
- Review and enhance patient navigator interviews with patients.
- Develop, implement, and maintain individualized care plans in accordance with internal protocols and accreditation standards.
- Provide evidence-based clinical interventions that align with individualized care plan goals.
- Collaborate with patient navigators to manage non-clinical aspects of care, such as appointment scheduling and transportation arrangements, while addressing social determinants of health (SDOH).
- Maintain ongoing patient outreach, continuously monitoring data and adjusting care plans as needed.
- Collaborate with primary care providers to create specific escalation plans for chronic condition management.
- Educate patients about their conditions and treatment options.
- Advocate for patients to access necessary services and resources.
- Follow up on referrals to ensure patient engagement.
- Maintain accurate documentation in the electronic medical record per protocol.
- Utilize evidence-based clinical protocols and quality metrics.
Qualifications
- Current and valid Registered Nurse license in good standing.
- Minimum of 3 years of RN Case Management experience in an outpatient setting.
- CCM certification preferred; candidates are required to obtain CCM certification within one year of employment.
- Supervisory experience is a plus.
- Strong written and verbal communication skills to interact empathetically with patients, families, and interdisciplinary teams.
- Proficiency with computer systems, including electronic medical record (EMR) and case management documentation.
- Knowledge of accreditation and quality standards, such as NCQA and HEDIS.
Preferred Qualifications
- Bilingual in English and Spanish is preferred.
Benefits
- Remote Work: Flexibility to work from home.
- Comprehensive Health Plans: Medical, Dental, and Vision coverage.
- Retirement Planning: 401(k) plan with a 3% employer match on your 6% contribution.
- Life and Disability Insurance: Coverage for peace of mind, with voluntary options available.
- Employee Assistance Program (EAP): Support during challenging times.
- Flexible Time Off: Options for balancing work and personal life.
- Parental Leave: Paid leave to support you during important family moments.
- Professional Development: Resources available for learning and career advancement.
Compensation
The base salary range for this position is between \(80,000 to \)85,000 per year, paid bi-weekly. Final salary decisions will be based on skills, experience, education, location, and licensure/certifications.
Commitment To Equal Opportunity Employment
We value diversity and inclusion. As an equal opportunity employer, all employment decisions are made without regard to race, color, age, sex, sexual orientation, national origin, disability, or any other classification protected by law. Our management is committed to upholding this policy across all employment practices.
Security Compliance
Adherence to security policies and procedures to protect patient health information (PHI) and organizational intellectual properties is required for this position.
Employment Type: Full-Time