PER DIEM Medical Case Manager occupation at Neighborhood Health Plan of Rhode Island in Providence

Neighborhood Health Plan of Rhode Island is presently looking of PER DIEM Medical Case Manager on Fri, 10 May 2013 01:37:51 GMT. Overview : The Medical Case Manager works collaboratively with the health care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care. Qualifications : Required : - Licensed RN, State of RI - BS Degree or Certification as a CM or RN with 3 years clinical...

PER DIEM Medical Case Manager

Location: Providence Rhode Island

Description: Neighborhood Health Plan of Rhode Island is presently looking of PER DIEM Medical Case Manager right now, this occupation will be placed in Rhode Island. More complete informations about this occupation opportunity please read the description below. Overview :
The Medical Case Manager works collaboratively with the health care team to manage and coordinate care for a spec! ific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.

Qualifications :
Required :

• Licensed RN, State of RI
• BS Degree or Certification as a CM or RN with 3 years clinical practice
• 3 years experience in acute care
• Computer literacy with Windows based programs
• Strong organizational and documentation skills
• Excellent customer service orientation
• Strong Interpersonal Skills

Preferred:

• Clinical specialty experience
• Medical review experience helpful
• Case Management certification a plus
• Clinical specialty certification a plus
• Bilingual ( English/Spanish) a plus
• Practice within the scope of his/her license

Duties and Responsibilities:
Responsibilities include, but are not limited to the following:

• Practice case management within the scope of lice! nsure.
• Utilizes case management principles and sound clinical judgment in coordinating care for a specific member population
• Performs telephonic and in-person intensive case management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to:
• Performing a comprehensive assessment
• Care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, Behavioral Health Professionals and other involved health care professionals and community agencies, as appropriate
• Implements care plan, facilitates referrals, coordinates services and resources and provides ongoing monitoring and re-evaluation of outcomes
• Continuous monitoring and evaluation of the care outcomes and identification of service gaps
• Regular review and revision of the plan of care in collaboration with the family and appropr! iate members of the health care team based on the outcomes and evaluative findings
• Off site visits ( such as but not limited to home hospital or Community health centers or other community agencies) as necessary or required
• Provides comprehensive documentation of all activities and contacts in Case Management software system
• Facilitates referrals and coordinates needed services
• Collaborates with Medical Review Nurse as necessary in identifying needed services and supports
• Calculates cost savings that may result from redirecting member to a more appropriate care setting ( i.e. PCP visit rather than ER)
• Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers
• Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timel! y manner
• Takes responsibility for professional development, su! pports a learning environment, and meets professional competency requirements
• Participates in department continuous quality improvement activities
• Provides clinical oversight to Community Outreach Specialists and other team members; providing direct supervision of Community Outreach Specialists as appropriate regarding individual case status
• Serves as a clinical resource to respond to questions from ancillary departments within Neighborhood
• Provides cross-coverage as assigned by Supervisor
• Participates in outreach/marketing activities as needed and as appropriate
• Other duties as assigned by Supervisor

Neighborhood is an EOE M/F/D/V and an E-Verify Employer
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Neighborhood Health Plan of Rhode Island.

If you interested on this occupation just click on the Apply button, you will be redirected to the official website

This occupation starts available on: Fri, 10 May 2013 01:37:51 GMT

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