Job Description
- Job Description:
- Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
- Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
- Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
- Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
- Interacts with members/clients telephonically
- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
- Prepares all required documentation of case work activities as appropriate.
- Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
- Provides educational and prevention information for best medical outcomes.
- Requirements:
- 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
- Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise.
- Reliable transportation required.
- Mileage is reimbursed per our company expense reimbursement policy
- 1+ year(s) of experience with Microsoft Office applications (MS Word, Excel, Outlook and PowerPoint)
- Active Compact License in NJ, PA or WV preferred
- Minimum 2+ years CM, discharge planning and/or home health care coordination experience
- Certified Case Manager is preferred.
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal skills.
- Efficient and Effective computer skills including navigating multiple systems and keyboarding
- Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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