As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Specialist Case Manager RN, under the direction of the Supervisor or Manager of Case Management provides direction, identifies health and psychosocial issues of a select member population and assesses, plans, implements, coordinates monitors and evaluates services and outcomes to ensure maximized health of the member. Assumes a leadership role within the interdisciplinary care team to achieve optimal clinical and resource outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Identifies issues relating to members' physical and mental well-being that affects health status and works in collaboration with both the member and provider to determine appropriate care for case management services.
In collaboration with the member and PCP completes a comprehensive assessment and develops a care plan assessing short-term and long-term needs.
Acts as a leader during interdisciplinary care team conferences to achieve optimal clinical and resource outcomes.
Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
Maintains and documents initial assessment; designs a care plan that is attainable and in the appropriate business application program.
Acts as a liaison between physician and member to alleviate potential issues that can interrupt care
Maintains case load by identifying cases that are no longer high in intensity or services and closes them timely and appropriately.
Schedules or facilitates scheduling appointments and follow-up services; requests consultation and diagnostic reports from network specialists; contacts members to remind them about upcoming appointments and/or missed appointments.
Maintains and promotes confidentiality of patient information and adheres to all HIPAA regulations
Participates in monthly case studies in the Medical Services Department
Other duties as assigned.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Experience in CM or other managed care environment.
Knowledge of disease specific states, clinical and community resources.
Strong critical thinking and problem solving skills.
Ability to network, advocate, communicate assertively with all customers.
Work involving high volume and strict timeframes.
Excellent communication skills.
Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus.
Ability to work in fast paced environment.
Works well independently as well as part of a team.
Strong commitment to help others.
Computer literate; must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Minimum Education: LMSW or RN
Licensure: Licensure must be current and unrestricted in the appropriate jurisdiction
Preferred Education: BA or BS in Nursing, MSW in Social Work
2+ years of experience in a clinical acute care position, preferably in home health, physicianâ��s office or public health
1 to 3 years disease management, case management or formal patient education experience;
Include minimum certification required to perform the job.
Licensure must be current and unrestricted in the appropriate jurisdiction
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Approximately 5% travel may be required
Job: Conifer Health Solutions
Primary Location: Westminster, California
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.