Case Manager, PPO - 26-126

PriMed Management Consulting Services, Inc.; United States; Remote; USD 100,000 - 123,000; Full time

Job summary

Hill Physicians Medical Group is seeking a Case Manager Registered Nurse to carry out telephonic case management for PPO members identified through data or Health Plan referrals. Responsibilities include assessing needs, developing care plans, coordinating with providers, and documenting in Epic.

Requirements include 3+ years nursing experience, 2+ years in case management in managed care, and California RN licensure. Salary range offered: $100,100–$123,000 annually.

Qualifications

• Three years minimum clinical nursing experience in medical/surgical, critical care, home health or skilled nursing.
• Two years of experience in case management, behavioral health, utilization management, discharge planning, and/or quality improvement in a managed care setting.
• Experience with managed care delivery including IPA networks and Medicare. PPO experience preferred.
• Strong organizational, time management, and communication skills.

Responsibilities

• Collaborate with Health Plans care and disease management programs to maximize the at-risk population member’s quality and manage their costs.
• Assess members’ physical and psychosocial needs and develop a care plan.
• Coordinate care and document in Epic; assessments, care plans, interventions, and all activity related to coordinating the care of case-managed members.
• Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.

Skills

Case management

Nursing

Communication skills

ICD-9/CPT knowledge

Independent work

Education

A.S. degree

RN licensure (unrestricted)

Tools

Epic

Job description

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&IE Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it’s right!

Job Description:

Responsible for carrying out case management activities for PPO members identified through data or by Health Plan and referred to HPMG. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet the client’s health and human service needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. Case management activities are based on nationally recognized case management standards and concepts and principles. All contacts are telephonic.

Job Responsibilities

• Collaborate with Health Plans care and disease management programs to maximize the at-risk population member’s quality and manage their costs.
• Assess members’ physical and psychosocial needs/barriers and develop a care plan.
• Support and encourage the use of participating Health Plan providers.
• Develop and implement the interventions needed to resolve barriers and coordinate care, allowing members to accomplish their goals with physician guidance and supervision.
• Document in Epic; assessments, care plans, interventions, and all other activity related to coordinating the care of case-managed members.

Additional Responsibilities

• Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
• Maintain department procedure/policy standards with regard to turnaround time, etc.
• Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
• Coordinate internal and external resources for the individual member.
• Maintain and update a community resource database.
• Document all case management activities in the HPMG case management online system.
• Issue letters of explanation in accordance with department policy.
• Attend and participate in in-service programs and conferences that support practice of case management.
• Perform other duties as assigned.

Required Experience

• Minimum three years clinical nursing experience in an area such as medical/surgical, critical care, home health or skilled nursing, and;
• Two years of experience in case management, behavioral health, utilization management, discharge planning, and or quality improvement in a managed care setting.
• Experience with managed care delivery including IPA networks and Medicare. PPO experience preferred.
• Optimum organizational skills with ability to meet both expected and unexpected time frames.
• Excellent verbal and written communication skills.
• Ability to coordinate effectively with a variety of customers including members, providers, office staff, health plans, internal department, community resources, and peers.
• Ability to work independently with self-initiative and discipline.
• Knowledge of ICD-9 and or CPT coding.
• Working knowledge of personal computers.

Required Education

• A.S. degree
• Unrestricted California Registered Nurse licensure; certification in case management preferred.

Additional Information

Salary: $100,100 - $123,000 Annual

Hill Physicians is an Equal Opportunity Employer