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 Disease Management. We help our members live well with their chronic health conditions. Our Disease Management nurses support our members with specific health-related conditions in developing improved knowledge to enhance self-management skills and adopting positive behavior changes along with assisting in navigating the healthcare system. Through collaboration with the multidisciplinary team, you will use your experience, expertise and clinical judgement to offer a lasting, positive experience for the members, families, providers and communities we serve.
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.
- Function as a primary educator for members with whom have specific health conditions for which the organization has formal disease management programs. Across the continuum of services the goal is always to help develop and support the member’s ability to self-manage and navigate the health care system and to provide members with resources and tools to assist in health-related decision making to optimize their clinical outcomes.
- Conduct clinical assessments through a variety of approaches that will include telephonic as well as face-to-face interventions depending on the model of care delivery. Clinical assessments with approved assessment tools and protocols address the condition specific health and wellness needs of members. Clinical and motivational interviewing skills are utilized with the goal of effecting members’ self-management and positive behavior changes to achieve condition related goals.
- Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals. Establish a plan for regular contact with each member to review progress and assess for additional needs. Monitor and report care plans and members reached as well as their progress towards program goals to the Highmark primary Complex Care Case Manager RN. Member reports will be provided on a regular (monthly or quarterly) basis as so assigned. Communicate with the member’s treating provider or other company team members when indicated.
- Identify on-line, telephonic and clinical resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services. Identify when members need a more advanced level of intervention or have reached goals and takes appropriate action.
- Proactively incorporates lifestyle improvement and prevention opportunities into member interactions, coaching and goals; incorporates and assists members in closing any gaps in care.
- Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Account for progress of members served and is accountable for results.
- Collaborate with behavioral health and other team members to provide co-management activities for members who require additional services. Participate in ongoing training and educational activities related to medical and behavioral health topics.
- Other duties as assigned or requested.
- 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 6 months of employment. Additional state licensure may be required.
- High School Diploma/GED
- 5 years of any combination of clinical, case management and/or disease/condition management experience
- Advanced training in disease management
- Advanced training and experience in cognitive behavior therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT)
- Experience working with the healthcare needs of diverse populations and understanding of the importance of cultural competency in addressing targeted populations
- Ability to communicate effectively in more than one language
- Understanding of the role of lifestyle in disease processes
- Call center experience desirable
- Excellent interpersonal and communication skills
- Broad knowledge of disease processes
- Understanding of healthcare costs and the broader healthcare service delivery system
- Proficient computer skills, including MS Office products
- Demonstrated ability to handle multiple priorities in a fast paced environment
Referral Level: 4
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