Clinical Case Manager Lead
The current healthcare landscape is ever-changing, but the desire to provide patients with better, more affordable care is consistent. Healthcare providers are working to evolve and support population health management and today’s value models, but there is still uncertainty in the market. Providers need a proven, integrated approach that takes the best of today’s technology and matches it with deeply experienced professionals.
Innovista Health Solutions is an Illinois-based service organization with management services operations in Illinois and Texas. We are currently looking for a Clinical Case Manager Lead in our Westchester, IL office. At Innovista, we believe that positive forward movement in today’s uncertain healthcare market stems from the combination of innovative programs and dedicated people. Join the Innovista team and lead the charge to a better, more efficient healthcare system.
The role of the Case Manager is to coordinate continuity of care for patients often as a liaison between the patient’s family and healthcare organization, ensuring that the proper treatment is administered at the appropriate time to maximize health and well-being while also minimizing the need for hospitalization. The Case Manager strives to promote self-managed care and the use of healthcare resources in the most cost-effective way possible, working with patients of all ages and conditions, but primarily focusing on a specific population. The individual in this position has overall responsibility for overseeing the clinical Plan of Care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning. The Clinical Case Manager Lead will serve as a resource to team members and management, in addition to managing a designated caseload.
DUTIES AND RESPONSIBILITIES:
- Implements a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.
- Identifies members appropriate for Case Management by use of targeted chronic conditions, level of care, and recognition of member’s condition specific and preventative measures, knowledge base or deficits in monitoring health, wellness and chronic conditions.
- Provides transitional care management, coordinating post-hospital care to prevent readmissions.
- Collaborates with the Provider or their designee to address the Plan of Care from an integrated approach.
- Implements, monitors and closes the Plan of Care to determine if the goals are being met on an ongoing basis to evaluate for needed changes and updates the plan of care accordingly.
- Conducts outbound calls to members to complete telephonic assessments and provide interventions and education for the management of member’s health, wellness and chronic conditions.
- Reviews and analyzes clinical indicators and whether there is any ‘gap’ in compliance with quality of care.
- Identifies and reports quality of care issues to the Medical Director and the Director of Population Health Manage
- Completes clear and concise documentation in Care Management program
- Prepares, participates and presents CM/DM reports to UM/QM Committee.
- Maintains accurate and timely documentation in the EHR and review cases using MCG and/or Interqual criteria.
- Collaborates with the internal staff to support and uphold the established guidelines and NCQA standards.
- Maintain personal professional development within clinical expertise.
- Participate in departmental and company in-services, meetings and/or conferences as appropriate
- Lead or assist with special projects
- Assist with training, mentoring and auditing of team members
- Able to manage complex cases with minimal assistance
- Performs other duties as assigned
- Registered Nurse (RN) with a current and active license to practice in the State assigned or maintain a compact license
- CCM highly desirable
- At a minimum 3 years of various clinical experiences preferred.
- 5 years of case management/care coordination experience
- Experience with Milliman Care Guidelines (MCG) or Interqual highly desirable.
- Ability to utilize skills to understand and coordinate care of those members that are significantly physically compromised by their illness and/or disability
- Ability to handle multiple demands of diverse workload and prioritizes critical i
- Ability to effectively communicate verbally and in writing to construct grammatically correct reports using standard medical terminology.
- Ability to analyze and think critically.
- Possesses current knowledge of disease pathophysiology, psychosocial issues, and treatment
- Positive, service-oriented attitude with high level of integrity.
- Proficient computer skills with Microsoft Office products and ability to learn department and job specific Software Systems.
- Ability to work independently as well as within a team in a fast-paced environment.
- Must maintain a valid Driver’s License and vehicle
- Ability to travel at least 30% for client meetings within the State.
- Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor; however, regular in-office presence is required, to be determined by supervisor.
Innovista is dedicated to hiring passionate individuals who embody our core values: integrity, determination, and teamwork. We recognize the importance of work-life integration and seek to provide our employees with competitive benefits, which include:
- Comprehensive health plan options, dental, and vision coverage subsidized by Innovista
- Opportunity to work from home, based on position and manager discretion
- Company-paid benefits, such as short- and long-term disability, employee life, and AD&D
- Discretionary bonus
- 401(k) with company match
- Opportunity for career advancement and growth
- Flex time options may be available
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