Population Health Case Manager RN

Population Health Case Manager RN page is loaded## Population Health Case Manager RN locations:
Corpus Christi, TXtime type:
Full time posted on:
Posted Todayjob requisition :
JR110544#
**** Where compassion meets innovation and technology and our employees are family.
***** Thank you for your interest in joining our team! Please review the job information below.
*** General Purpose of Job:
** Case Management is a collaborative practice that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the member’s  health and human service’s needs. It is characterized by advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes. The Case Manager facilitates clinically appropriate and fiscally responsible patient care through communication with the treating physicians, and all other members of the health care team.

The Case Management Process is centered on a client/support system. It is holistic in its coverage of the client’s situation and addresses medical, physical, emotional, financial, psychosocial, behavioral, emotional, and other needs, as well as that of the member’s support system. The case manager screens the member to identify the need for case-managed services by conducting a series of assessment activities including:
1) reviewing the member’s current and past health and medical history, vocational history, and functional status
2) stratifying the member’s risk (low, moderate, or high) after a comprehensive assessment and
3) identifying the member’s specific or chief complaint(s), including actual and potential problems. The Case Management Process consists of nine phases through which Case Managers provide care to Driscoll Health Plan members:
Screening, Assessing, Stratifying Risk, Planning, implementing (Care Coordination/Planning), Following Up, Transitioning, Communicating Post Transition, and Evaluating. The overall process is iterative and cyclical, its phases being revisited as necessary until the desired outcomes are achieved and the members’ interests are met.
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* Essential Duties and Responsibilities:

** To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  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. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the Director of Case and Disease Management as required.
** General Responsibilities**:
* Maintains utmost level of confidentiality at all times.
* Adheres to Health System and Health Plan policies and procedures.
* Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
** Case Manager’s Responsibilities:
**** Knowledge**:
* Be knowledgeable in Medicaid criteria/guidelines.
* Be knowledgeable about managed care contracts/guidelines.
* Be knowledgeable of data-driven decision-making tools and their use.
* A working knowledge of various reimbursement mechanisms, including third party requirements.
* Current working and demonstrated knowledge of various criteria sets (i.e., Inter Qual) preferred.
** Responsibilities:
*** Communicating with members and their support systems, as well as other healthcare providers.
* Apply plan benefits consistently for each line of business.
* Provides ongoing oversight, availability and monitoring of non-clinical staff activities.
* Identify members with special health care needs for possible disease management programs available within the plan.
* Negotiate with vendors when necessary for services/equipment.
* Ensure appropriate referrals/authorizations to agencies, assistance programs, physicians and other healthcare related programs are completed within established turnaround times.
* Coordinate appropriate Community/health agency referrals.
* Report, as appropriate, potential adult/elder/child abuse cases to appropriate agency and…