Complex Case Manager - RN $5000 sign on bonus

Job ID: J116058
Company: Highmark Inc
Location: Home, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

JOB SUMMARY 

This position is eligible for a generous $5,000 sign on bonus!

Join our team and make a difference in the lives of the members we serve by providing best in class Complex Case Management.  You will offer a lasting, positive experience for the members, families, providers and communities.  Through collaboration with the multidisciplinary team use your experience, expertise and clinical judgement to assure the right level support at the right time.   You will help chronically ill members with complex needs achieve personal health goals while identifying and addressing barriers that get in the way of living well. 

Please note this position requires you to complete a brief talent questionnaire. This will be emailed to you to complete after you apply.

This position is eligible to work remotely – please note you will need to come into the office for the first 3 – 4 months for initial training.

ESSENTIAL RESPONSIBILITIES

  • Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
  • For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
  • Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
  • Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.

  • Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.

  • Other duties as assigned or requested.

QUALIFICATIONS

Required

  • RN license in PA, WV, and DE is required. At least one of these state licensures must be active at time of hire. Others must be obtained within the first 6months of employment.  Additional state licensure may be required.
  • 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
  • High School Diploma/GED

Preferred

  • Bachelor's Degree in Nursing
  • Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
  • Experience working with the healthcare needs of diverse populations
  • Understanding of the importance of cultural competency in addressing targeted populations
  • Certification in Case Management

SKILLS

  • Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
  • Broad knowledge of disease processes
  • Understanding of healthcare costs and the broader healthcare service delivery system
  • Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
  • Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
  • Ability to work in a high performing team environment that requires flexibility
  • Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills
  • Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Referral Level: 4

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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