Integrated Care Manager

Socket.dev; Chicago (IL); On-site; USD 70,000 - 110,000; Full time

Job summary

Zing Health is seeking an IntegratedCare Manager to conduct health risk assessments, coordinate care and lead care management for MAPD, C-SNP and D-SNP members. You will apply CMS and internal criteria to guide care and work with the care team to ensure smooth transitions of care.

The role requires 3+ years in wellness or managed care, an active nursing or allied license, and strong communication skills. Travel within the territory is expected as part of care delivery.

Qualifications

• 3 years of wellness or managed care experience presenting clinical issues with members/physicians.
• Current, valid, unrestricted license in the state of operations.
• Demonstrates strong clinical knowledge and ability to perform clinical assessments.

Responsibilities

• Coordinate care for members using CMS & Zing Health approved medical necessity screening criteria.
• Coordinate ancillary services (home health, DME) as needed.
• Follow patient through transitions of care to close gaps in treatment plans.

Skills

Clinical assessment

Care coordination

Case management

Communication skills

Travel availability

Education

Licensed RN/LPN/LPC/LCPC/LMSW/LSW/LCSW/LMHC

Tools

EMR systems

Microsoft Office

Job description

About Zing Health

Zing Health Holdings, Inc. is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

JOB DESCRIPTION

The IntegratedCare Manager will be responsible for conducting health risk assessments, coordinationof care and caremanagement for MAPD, C-SNP and D-SNP members.

FundamentalComponents includes but is not limited to:

• Coordinatescare for members utilizing CMS & Zing Health approved medical necessityscreening criteria (i.e., NCD, LCD, InterQual, etc.).
• Coordinates ancillary services asneeded (home health, DME, etc.).
• Followspatient through various transitions of care to ensure that any gaps intreatment plans are identified and remedied and promote efficient health caredelivery.
• Participatesin assessment activities to develop individualized plans of care incoordination with patient, family, and providers.
• Appliescase management standards of practice to focus on effective care of high-riskhigh-need patients.
• Serves asa patient advocate and resource and provides critical information andrecommendations to the rest of the care team.
• Maintainsstrong knowledge of UM, Case management, community resources and plan benefitsto promote improved member experience and health outcomes.
• Workscollaboratively with the member (and caregivers), primary care physicians,specialists, and other care providers to ensure member compliance and adherenceto medical plan of care.
• Assists HealthServices Team in implementing best practices for chronic care and diseasemanagement.
• Followsstandard protocols, processes, and policies.
• Provides membereducation to assist with self-management and encourages members to make healthylifestyle changes.
• Interactswith Medical Directors, Pharmacists, Behavioral Health Clinicians, and OtherImpact Team Members on challenging cases
• Makesreferrals to outside sources.
• Documentsand tracks clinical reviews, member care plans, referrals, and findings.
  
• Performsother duties, projects and actions as assigned

Qualifications Requirements and Preferences

• • RegisteredNurse (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), LicensedProfessional Counselor (LPC), Licensed Clinical Professional Counselor (LCPC),Licensed Master Social Worker (LMSW), Licensed Social Worker (LSW), LicensedClinical Social Worker (LCSW) OR Licensed Mental Health Counselor (LMHC) with 3years direct clinical care to the consumer in a clinical setting.
  • Current,valid, unrestricted license in the state of operations (or reciprocity). Forcompact licensee changing permanent residence to state of operations, you mustobtain active, unrestricted RN licensure in the state of operations within 90days of hire.
  • 3 yearsof wellness or managed care experience presenting clinical issues withmembers/physicians.
  • Demonstratesstrong clinical knowledge, ability to perform clinical assessments onCardiology patients, ability to use critical thinking skills and has thecapacity for continued learning.
  • Knowledgeof UM and plan benefit designs.
  • Demonstratedability to perform case management & disease management activities.
  • Abilityto demonstrate knowledge of and apply those to the job function andresponsibilities.
  • Problemsolving skills; the ability to systematically analyze problems, draw relevantconclusions and devise appropriate courses of action.
  • Verbaland written communication skills including listening, discussing anddocumenting medical needs with members, providers, internal staff/management,external vendors, and community resources.
  • PCproficiency to include Word, Excel, PowerPoint, database experience and Webbased applications.
  • Currentdriver’s license, transportation and applicable insurance.
  • Abilityand willingness to travel within assigned territory.

PreferredSkills

• UM, CM orDM experience with a Managed Care Organization (MCO)
• Patienteducation experience.
• Bilingual– English and Spanish
• Knowledgeof the health and wellness marketplace and employer trends.
• Experiencein managing complex or catastrophic cases.
• Certificationin Case Management, Training, Project Management or nationally recognizedhealth care certification.
• Personalmanagement skills — Plan and manage multiple assignments and tasks, setpriorities and adapt to changing conditions and work assignments. Teamwork—ability to work well with one or more groups.
• Interpersonaleffectiveness — Relate to co-workers and build relationships with others in the organization.
• Strongwork values — Dependability, honesty and a positive attitude.