Job Description:
Job Summary:
The Care Manager supports the implementation of the Value Based Care Management
program in an appropriate and efficient manner by providing high-quality telephonic Case or Care Management with CareFirst members. The Care Manager partners with members, caregivers, providers, and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to improved health outcomes. The Care Manager will advocate and guide utilizing motivational interviewing techniques and intervene on behalf of their members to ensure successful completion of member goals, while providing Complex Case Management and/or care management support through the duration of the care plan.
Essential Job Functions:
- Engage telephonically with members, caregivers, and providers to develop a comprehensive plan of care, identify key strategic interventions, and address the members needs at various stages along the care continuum.
- Serve as an extension of the care team by collaborating with PCPs, specialists, other clinicians, and member to meet health care goals through development and implementation of Care Plans.
- Assess the member’s ongoing care needs and progress towards goals throughout the plan duration and make revisions as needed to address changes in the member’s condition, lack of progress toward goals of the care plan, preference changes, and transitions in care settings. Coordinates plan of care with goals of member stabilization, decreased admissions, medication management, behavior change and ability to self-manage.
- Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member.
- Identify relevant benefit and community resources, evaluates Social determinants of Health and facilitates referrals based on member need.
- Assist the member in coordination of any additional tests, images and consults with specialists.
- Perform medication reconciliation at the onset of care plan, after changes in health status, and every thirty days during the life cycle of the care plan, assessing for efficacy and drug interactions/side effects.
- Facilitate and monitor the transition of care which involves moving the member from one healthcare practitioner to another as their healthcare needs change. Implements and oversees the agreed upon plan of care as well as coordinates member follow-up post discharge.
- Utilize established documentation standards to maintain quality of care plan documentation to include member progress toward their established state of being and barriers to achievement of care plan objectives and outcomes.
- Abide by Value Based Care Management Program Description and Guidelines.
- Meet productivity and quality metrics as outlined by leadership for each year.
- Complete mandatory training and annual competency testing.
- Actively participate in team huddles and contribute to clinical learning.
- Remain current on clinical knowledge via self-directed learning.
Specific Skills/ Attributes:
- Strong motivational interviewing and case management skills.
- Ability to be self-directed, highly organized, multi-task capable, and proficient in problem solving skills.
- Ability to meet established deadlines.
- Exceptional oral, written, and presentation skills.
- Ability to effectively communicate and provide positive customer service to internal and external customers, meeting the expectations for service excellence.
- Successfully partner with all levels of administrative and professional personnel.
- Demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads.
- Success with engaging members. Outstanding customer service skills and ability to adapt approach to various personalities.
- Ability to extrapolate information from a variety of sources including medical records to create concise records that accurately depict the medical “story” of the member.
- Proficiency with data analysis and ability to organize data in support of reporting needs.
- Ability to proactively identify and assimilate quality improvement processes into practice.
- Experience with medically oriented care plan documentation.
- Experience working effectively within a matrix organizational design.
Qualifications:
- Current multi-state compact Registered Nurse licensure in state of residence is required, with ability to obtain additional licenses without restriction. BSN preferred.
- Training in motivational interviewing preferred.
- Minimum 3-5 years varied clinical experience with telephonic Case Management experience strongly preferred.
- Demonstrates computer competencies to include electronic medical records, word processing, spreadsheet, presentation preparation, and. Demonstrated ability to learn customized computer applications.
- Maximize all technology inclusive of Microsoft Teams, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, and all other relevant unified communication technologies.
- This position will be based from a home office which must satisfy all HIPAA requirements and minimum internet connectivity requirements.
- Ability to communicate with members, other members of the team, physicians, and plan representatives.
- Ability to read, analyze, and interpret common scientific and technical journals. Ability to effectively present information to audiences with a variety of knowledge/skill levels
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law.