High Risk Case Manager (Premier Medical) Position Available In Lake, Florida
Tallo's Job Summary: The High Risk Case Manager position at Premier Medical involves promoting quality, cost-effective outcomes by coordinating care, advocating for member needs, and ensuring desired health and social outcomes. Responsibilities include collecting clinical data, facilitating care transitions, and collaborating with interdisciplinary teams. Candidates should have an associate degree in nursing, 2 years of clinical experience, and knowledge of medical management standards. The role requires critical thinking, communication skills, and the ability to work independently in a fast-paced environment. Premier Medical is an Equal Opportunity Employer committed to diversity and inclusivity in the workplace.
Job Description
Back to Career Site We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
JOB SUMMARY
The role of the Case Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Case Manager is responsible for providing patient centered care across the care continuum.
DUTIES & RESPONSIBILITIES
Collect relevant clinical data to support the care planning process. Provide care plan support, intervention, and prioritization to transition members to optimal levels of health and self-management. Participate in interdisciplinary team meetings as required. Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population. Provide transition of care interventions as required. Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population. Facilitate linkage to appropriate community resources to address social determinants of health. Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care settings. Ensure member communication and notices are composed in a manner consistent with regulatory standards. Adhere to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.
EDUCATION AND PROFESSIONAL EXPERIENCE
Associate degree in nursing, preferred. Minimum 2 years of experience in medical management clinical functions. Working knowledge of MCG, InterQual, and NCQA standards Active License as a Licensed Vocational Nurse (LVN) or RN is preferred Certification in Managed Care Nursing (CMCN) preferred.
PROFESSIONAL COMPETENCIES
High level of critical thinking and problem-solving skills Strong work ethic and overall positive attitude Effective communication skills including verbal and written. Ability to manage time effectively, understand directions, and work independently in a fast-paced environment. Demonstrated flexibility, organization, and self-motivation. Highly adaptable to change. As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
