Case Manager (CA - 24x7) - : 389987 occupation at Monarch HealthCare in Monarch

Monarch HealthCare is hiring Case Manager (CA - 24x7) - : 389987 on Fri, 24 Aug 2012 17:04:07 GMT. SUMMARY : To perform a care continuum process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes. The Pioneer ACO (Medicare FFS) Ambulatory Care Team Nurses are responsible for the identification, evaluation and...

Case Manager (CA - 24x7) - : 389987

Location: Monarch Montana

Description: Monarch HealthCare is hiring Case Manager (CA - 24x7) - : 389987 right now, this occupation will be placed in Montana. Further informations about this occupation opportunity please give attention to these descriptions. SUMMARY : To perform a care continuum process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes.

The Pioneer ACO (Medicare FFS) Ambulatory Care Team Nurses are responsible for the identification, evaluation and coordination of all health care services provided to a select Medicare population. These services include; supporting the continuum of care, i.e. benefits and coverage thru care coordination, ambulatory case management, disease management and any other appropriate services required for total care of the Pioneer ACO members' health care needs. Nurses are also responsible for providing relevant and measurable outcomes to the administration, Management Committees.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Review Clinical data thru applicable stratification tools for the Medicare FFS population to identify Medicare FFS patients at risk that could benefit from Ambulatory Case Management services and programs and in accordance with nationally recognized standards. 2. Coordination of services among medical personnel, allied health professionals, funding sources and community agents to ensure smooth delivery of Covered Services and support the Triple Aim Goals for Pioneer ACO Medicare members. 3. Develop and monitor a comprehensive care plan to include, but not limited to, long term goals, short term goals, coordination of benefits, self-management plan and outcomes. 4. Develop and maintain an effective working relationship, to include communication and care management, with physicians and other MHC staff. 5. Provide members and providers with support and tools that positively impact the short term and long term health conditions of the Medicare population aligned with. 6. Act as liaison between member, Pioneer Care Team, Community and aligned healthcare providers, CMS and MHC Medical Directors. 7. Coordinate out-of-network and out-of-area cases with Pioneer members as needed accessing and adhering to CMS Local and National Coverage Policy and Guidelines. 8. Provide alternative health care services utilizing contracted, community and internal services/programs and agreed to by providers and Pioneer members and/or representatives to meet the members' healthcare goals and needs. 9. Utilize clinical knowledge to apply any/all MHC approved evidence-based practice guidelines and criteria and well as other relevant and appropriate CMS and Community based practice standards for the Pioneer Medicare population. 10. Attend/coordinate Patient Care Conferences, on and off-site as necessary. 11. Maintain comprehensive and confidential case files. 12. Refer Pioneer Medicare members to other appropriate MHC Programs including; Disease/Condition Management programs, Homebound, High Risk Touch team, Palliative and possible Hospice service or programs. 13. Work in collaboration with Clinical Services, and other Monarch departments as the "subject matter" expert for Medicare FFS benefits and applications of these benefits per CMS. 14. Collaborate with the Clinical Services Trainer and Clinical Management to identify, design and deliver training modules to promote improved performance and/or to implement new regulatory guidelines pertinent to Pioneer Care Team activities. 15. Assist with the evaluation and revision of CM policy and procedures. 16. Provide any/all Committees with comprehensive summary of all active ACM cases as required 17. Present as a professional representative of Pioneer ACO and MHC. 18. Perform additional duties/tasks as assigned by the Manager. 19. Maintain and comply with all MHC policy and procedures. 20. Attend in-services, training and meetings relating to job tasks as directed and required. Requirements:

To perform this job successfully, an individual must be able to perform each essential duty. 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.

EDUCATION and/or EXPERIENCE:

  • Graduate of an accredited School of Nursing.
  • Minimum of three (3) years recent acute care or managed care experience.
  • Minimum of two (2) years recent care/case management experience.
  • Knowledge and experience in pre-authorization and referral management process.
  • Use of Community resources in care management.
  • Knowledge and use of State and Federal programs, including Medicare FFS within the Pioneer ACO within case management and utilization management process
SKILLS AND ABILITES:
  • Excellent verbal and written communication skills.
  • Good to excellent computer skills.
  • Self-motivated with effective critical thinking skills.
  • Ability to work collaboratively as part of the Case Management department team and all other areas providing member services or support.
  • Thorough knowledge of managed care, third party payers, regulatory requirements and government entitlement programs.
  • Excellent telephonic etiquette.
  • Ability to multi-task and set priorities.
  • Able to work independently.
LANGUAGE SKILLS:
  • Analyze, and interpret job related scientific and technical journals, financial and data reports and legal documents.
  • Respond effectively verbally and in writing to inquiries or complaints from customers, regulatory agencies or members of the business community.
  • Communicate assertively as well as collaboratively with Management, staff, health plans, physicians, and patients.
  • Effectively present information to management team.
  • Bi-lingual desirable.
MATHEMATICAL SKILLS:
  • Apply concepts such as fractions, percentages, ratios and proportions to practical situations.
  • Read and interpret daily department reports that include raw data, trends displayed in graphs.
  • Explain, share and use this data with all staff members.
REASONING ABILITY:
  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Ability to set priorities, define and implement effective workflow and processes.
CERTIFICATES, LICENSES, REGISTRATIONS:
  • Current and valid, unrestricted, California Registered Nursing (RN) license, Current Certified Case Manager (CCM) preferred.
  • BSN or equivalent preferred.
Skills / Requirements See above
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Monarch HealthCare.

If you interested on this occupation just click on the Apply button, you will be redirected to the official website

This occupation starts available on: Fri, 24 Aug 2012 17:04:07 GMT



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