1,660 Care Management jobs in the United States

The Care Management Coordinator, RN is responsible for using established criteria to determine if inpatient admissions, outpatient services, home health or home infusion therapy services are medically necessary. The Care Management Coordinator follows cases through the review process determining medical necessity of continuation of services and the appropriateness of the treatment setting. The Care Management Coordinator is responsible for identification of high-risk members and recognizing members that may require discharge planning assistance or those that meet criteria for referral to Case Management or Quality Management.

Job-Specific Requirements:

• Bachelor’s degree in Nursing and RN licensure that is unrestricted in the state of

Mississippi required. Master degree in Nursing preferred.

• Minimum two years of clinical experience required.
• Background in Utilization Review in the health care field is preferred.
• Excellent clinical thinking skills required.
• Excellent oral/written communication skills are required.
• Must have excellent organizational skills in order to successfully prioritize tasks and to ensure deadlines and benchmarks are consistently met.
• Must be able to work a flexible schedule when required.
• Must have above average PC skills and intermediate knowledge of Microsoft

Office.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.

Summary of Position:

The Care Coordinator is a trained professional that helps patients manage their chronic conditions by calling patients monthly. Monthly calls will include assessing current health status, educating patients about their chronic conditions, answering questions and acting as a resource between the patient and the provider, addressing any urgent patient needs, and following up on any changes in patient condition.

Job Duties & Responsibilities Include but are Not Limited to: 

• CCM monthly calls or verbal enrollments.
• Other services such as Health Risk Assessments, Transitional Care Management, Remote Patient Monitoring, etc.
• Communicate with patients and family members about their chronic conditions, medications, quality measures, barriers to care, and practice-specific requests.
• Communicate effectively with providers, staff, and other healthcare professionals.
• Promote adherence to a care plan developed in coordination with the patient, primary care provider, and family/caregiver(s). 
• Increase patients ability for self-management and shared decision-making, and assist patients in reaching established goals.
• Medication reconciliation. 
• Connect patients to relevant community resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction, and reducing healthcare costs
• Represent CCS in a caring and professional manner to providers and other healthcare professionals.
• Comply with organizational guidelines and healthcare laws and regulations, including CMS guidelines.
• Be flexible and a team player.
• Maintain expected call volume (see Call Expectations Policy).

Required Skills and Qualifications:

• Unencumbered active CMA/RMA certificate or unencumbered active compact license LPN/RN.
• Active BLS certification
• Ability to plan and organize time effectively, work independently, and show good judgment.
• Excellent problem solving, clinical reasoning, and critical thinking skills.
• Ability to communicate effectively both verbally and in writing.
• Knowledge of CCM regulations and of CCM billing requirements.
• High proficiency in working within EHR systems.
• Operational knowledge of Google Suite, Atlas, and other required software.

Home Office:

Care Coordinators must have a HIPAA-compliant workplace that is free of any distractions. The workplace must be in a room with a locked door to prevent accidental PHI disclosures. The home office must have high-speed internet and a CCS-approved computer with two monitors.

Physical Demand: 

Includes but is not limited to vision, hearing, repetitive motion, typing, and sedentary extended viewing of a work environment computer screen.

Reasonable accommodations may be made, with advanced notice, to enable individuals with disabilities to perform the essential functions and expectations of the position without compromising patient care.

PM25 

Compensation details: 21.5 Hourly Wage

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