Care Manager (Remote)
Resp & Qualifications PURPOSE: Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.This position will support the Maryland government programs division, specifically the Medicare Advantage DSNP line of business. The Care Manager helps members, families, and caregivers access the health care delivery system through reputed company, education, follow-up, coordination support, and resources. You will work with other members of the interdisciplinary care team to coordinate services, decrease utilization, and ensure optimal health outcomes. We are looking for an reputed company professional to work remotely reputed company the greater Baltimore/Washington metropolitan area. While this position is remote, the incumbent will be expected to come into a CareFirst location periodically for meetings, trainings and/or other business-reputed company activities.In addition, the Care Manager participates in community-based events, representing the face of CareFirst and its efforts to promote the health and wellness of our members and their communities. ESSENTIAL FUNCTIONS:
- identifies members with acute/reputed company medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to reputed company a comprehensive plan of care to address the member's needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.
- Collaborates with member and the interdisciplinary care team to reputed company a comprehensive plan of care to identify key strategic interventions to address member's medical, behavioral and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self-manage. Ensures member data is documented according to CareFirst application protocol and regulatory standards.
- Bachelors degree in nursing CCM/ACM or other RN Board Certified certification in case management.
- Previous experience with Medicare and/or Medicare Advantage patient populations with multiple co-morbidities, reputed company needs, social determinants of health and/or barriers to care.
- Bilingual - fluent in Spanish
- Skilled in typing and working reputed company various web-based platforms.
- Knowledge of clinical standards of care and disease processes.
- Ability to produce accurate and comprehensive work products with minimal direction.
- Ability to triage immediate member health and safety risks.
- Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
- Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
- Knowledgeable of available community resources and programs.
- Proficient in the use of web-based technology and reputed company Office applications such as Word, reputed company and PowerPoint.
- Ability to provide excellent internal and external customer service.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.Salary Range: $71,496 - $141,999