Company Overview
We are a data-driven healthcare organization committed to operational excellence. Our mission focuses on making quality healthcare affordable, enhancing patient health, and supporting healthcare providers in their practice. Leveraging AI and predictive analytics, we prioritize strong connections between patients and healthcare providers through embedded Healthguides™ and a centralized Managed Service Organization. Our physician-led approach empowers partners to deliver high-quality healthcare centered on positive outcomes and value for all patients.
Role Overview
In this role, you will collaborate with clinical teams to provide comprehensive case management and strengthen the relationship between patients and their primary care physicians. Your focus will be on assisting patients in achieving their highest level of wellness, addressing complex medical conditions, socio-economic factors, and mental health co-morbidities. Responsibilities include assessing, planning, implementing, coordinating, monitoring, and evaluating options and services to optimize patients’ health outcomes, while working closely with patient care navigators and other care team members to ensure optimal quality, clinical, and financial results.
Key Responsibilities
- Conduct comprehensive assessments of patients’ healthcare and psychosocial needs.
- Review and enhance patient navigator interviews with patients.
- Develop, implement, and maintain individualized care plans that meet internal protocols and accreditation standards.
- Provide evidence-based clinical interventions aligned with individualized care plan goals.
- Collaborate with patient navigators to manage non-clinical elements of care, including appointment scheduling, transportation arrangements, and addressing social determinants of health (SDOH).
- Maintain ongoing outreach to patients, continuously monitoring data and adjusting care plans as necessary.
- Collaborate with primary care providers to create specific escalation plans for managing chronic conditions.
- Educate patients about their conditions and available treatment options.
- Advocate for patients, assisting them in accessing necessary services and resources that require clinical knowledge or training.
- Follow up on service or resource referrals to ensure patient engagement.
- Keep accurate and up-to-date documentation in the electronic medical record as per protocol.
- Utilize evidence-based clinical protocols and guidelines along with defined 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 must 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 the interdisciplinary team.
- Proficient computer skills, with the ability to learn various electronic medical record (EMR) and case management documentation systems.
- Knowledge of accreditation and quality standards, including NCQA and HEDIS.
Preferred Qualifications
- Bilingual in English and Spanish is preferred.
Benefits
We value your contributions and are committed to ensuring that you and your family have access to the care you need. Our benefits include:
- Remote Work: Enjoy the flexibility of working from home.
- Comprehensive Health Plans: Medical, Dental, and Vision plans are available.
- Retirement Planning: 401(k) plan with a 3% employer match on your 6% contribution.
- Life and Disability Insurance: Providing peace of mind with voluntary options available.
- Employee Assistance Program (EAP): Access support when needed.
- Flexible Time Off: Helping you achieve work-life balance.
- Parental Leave: Paid parental leave for support during important times.
- Professional Development: Resources 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 considerations will take into account various factors, including skills, relevant experience, education, location, and licensure/certifications.
Commitment to Equal Opportunity Employment
We value diversity, inclusion, and belonging. As an equal opportunity employer, we ensure that employment decisions are made without regard to race, color, age, sex, sexual orientation, national origin, disability, or any other classification protected by applicable laws.
Security Compliance
This position requires adherence to all security policies and procedures to protect patient health information (PHI) and organizational intellectual properties.
Employment Type: Full-Time