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Job detail

Case Manager RN (50924)

GLOBALHEALTH HOLDINGS LLC

Employer page

#Registered Nurse #Patient Advocacy #HIPAA #Managed Care #PHI #Care Management #ICP #HRA #HMO #Disease Management #Utilization Management #Medicare Advantage

Full Time Remote Ok 2-5 yrsPosted 12 days agoCloses Jun 30

Location

Oklahoma City, Oklahoma

Quick overview

Perform telephonic case management for high-risk members to improve long-term wellness through care coordination and advocacy. Coordinate with providers and community resources to ensure holistic outcomes and educate members on self-management techniques.

Requirements summary

Requires an active Registered Nurse license in Oklahoma, with a multi-state license preferred. Candidates should have knowledge of nursing processes, disease management, and proficiency in Microsoft Office software.

high schoolCase ManagementPatient AdvocacyHIPAA CompliancePatient EducationCrisis InterventionCare CoordinationMicrosoft ExcelMicrosoft WordMicrosoft PowerPointDisease ManagementMedication ReconciliationTelephonic Case ManagementHRA Completion

Job description

Job DetailsJob Location

Any
Location
Remote
US -
Oklahoma
City,
OK 73102Position
Type:
Full
TimeEducation
Level:
High
School or
EquivalentTravel
Percentage:
NoneJob
Shift:
DayJob
Category:
NurseWHO
WE
ARE: GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
WHO
YOU
ARE: This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.
Essential
JOB
FUNCTIONS: Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures. Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes. Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges. Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention. Coordination of services for members, including community resources and collaboration with other members of the care team. Educate members and their caregivers on conditions and self-management techniques. Initiate and participate in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT. Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.
QualificationsEDUCATION
AND
EXPERIENCE: Active Registered Nurse license in the state of Oklahoma required Active multi-state RN license is preferred Previous experience in managed care/utilization management preferred
Knowledge,
SKILLS
AND
ABILITIES: Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources. Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals. Must be able to communicate, both orally and in writing, clearly and effectively Knowledge of Microsoft software programs including Word, Excel, and PowerPoint. Proven ability to work independently or as a member of a team.
WORK
ENVIRONMENT: Current work environment is remote, however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.
TRAVEL:
N/A
Supervisory
Responsibility:
N/A
OTHER
DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.