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Contract Oct 3, 2024 Other Area(s) Currently searching for a creative Copywriter who is dedicated to working with others to better understand project expectations, produce content with the needs of the employer in mind, participate in the brainstorming process, and conduct research to develop or support writing. This position is fully remote. M-F, 8am to 5pm.
Must Have Skills:
Familiar with Managed Care Organization editorial style guide, or can quickly and efficiently apply details of the guide to the task whose requirements include but are not limited to:
Overall Word document formatting (justification; line spacing)
Consistent font alignment
Consistent URL formatting
Consistent phone number formatting
Spelling accuracy
Grammar accuracy
Requirements
Knowledge of Microsoft Office Applications
Strong creative thinking skills and ability to think conceptually
Comfortable working independently with little direction under tight deadlines
Excellent writing, editing, and proofreading skills with a diligent eye for detail, language, flow, and grammar
Proven ability to demonstrate brand voice
Strong attention to detail
Education/Experience
Bachelor's degree in English, Journalism, Marketing, or Communications
3-5 years experience in content marketing or copywriting, preferably with a healthcare organization
Contract Oct 3, 2024 Other Area(s) Admin/Clerical - Office/Mail Clerk I
This position is onsite M-F 8am-4:30pm or 8:30am-5pm EST
1075 Main Street, Suite 400,
Waltham, MA 02451
Job Summary
Sorting and scanning incoming mail and sending to appropriate departments in a timely manner to ensure compliance requirements are met. Handling inbound email. Perform a variety of clerical functions including data entry. Ability to support a team with flexibility and accuracy.
Essential Functions:
Sort, date stamps and distribute mail/faxes/packages daily within set time frames.
Assist in maintaining files as needed.
Scan documents as requested.
Print documents as requested.
Mail and file all department documents with accuracy, efficiency and in a timely manner. Includes folding, mailing, filing.
Keep printers and printer areas stocked.
Prepare mailings and packages, send out.
Coordinate, upload and maintain department documents for multiple health plans using multiple applications in an accurate and complete manner.
Required Education
High School Diploma or GED
Required Experience
1+ years
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
Contract Oct 2, 2024 Other Area(s) Case Manager I (Social Worker or Healthcare Administrator) in the Lee County (Cape Coral or Ft Meyers area). The position is remote but will require field visits to members’ homes/ALF or SNF. The work scheduled is M-F, 8:00am – 5:00pm EST.
Day to Day Responsibilities:
Get services that you are eligible to receive
Set up appointments every 90 days or as needed
Arrange for transportation if member needs it
Identify any gaps in care or health care needs
Access resources to help you with special health care needs and assist your caregivers with day-to-day stress
Coordinate moving from one setting to another. This can include being discharged from the hospital
Assess eligibility for long-term care services and support
Connect with community resources
Find services from additional resources, including community and social services programs like physical therapy or "Meals on Wheels"
Arrange for services with a primary care provider (PCP), family members, caregivers and any other identified provider
Must Have Skills:
Good with computer systems and be able to learn a new system.
Experience with conducting clinical reviews and processed denials and partial denial determinations.
Reviewing for Medicaid/ MLTC members.
Must know Medicaid/ Medicare guidelines.
Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.
Required Years of Experience:
At least 1-2 years’ experience.
Required Licensure / Education: BA in related fields like Social Work, Health Administration. If licensed must be unrestricted and in good standing
Contract Oct 2, 2024 Other Area(s) Care Review Clinician I to assess, facilitate, plan and coordinate an integrated delivery of care, including behavioral health and long-term care, for members with high need potential. MUST reside in the Miami-Dade, FL area. This is a work from home position but will require face-to-face visits in members’ home/Assisted Living Facilities or Nursing Home Facilities. Schedule M-F 8:30am-5:00pm.
KNOWLEDGE/SKILLS/ABILITIES
• Completes face-to-face comprehensive assessments of members per regulated timelines.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for Molina members.
• Assesses for medical necessity and authorize all appropriate waiver services.
• Evaluates covered benefits and advise appropriately regarding funding source.
• Conducts face-to-face or home visits as required.
• Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member’s health and welfare.
• 50-75% local travel required.
REQUIRED EDUCATION:
• Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master’s degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background
REQUIRED EXPERIENCE:
• At least 1 year of experience working with persons with disabilities/chronic conditions and Long-Term Services & Supports.
• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.
PREFERRED EXPERIENCE:
• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• 1 year experience working with population who receive waiver services.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Active and unrestricted Certified Case Manager (CCM)
Active, unrestricted State Nursing license (LVN/LPN) OR Clinical Social Worker license in good standing
Contract Sep 30, 2024 Healthcare ilingual candidates are encouraged to apply!
Involved in the development, presentation and delivery of community outreach initiatives, activities and market strategies to support the Medicaid business and drive membership retention and growth.
Must be an Indiana resident who resides in or near Marion County, Indiana, willing to travel throughout central and northern Indiana
Conduct outreach activities for community members that are Aged, Blind, and Disabled
Collaborate with local agencies and medical providers that serve the HCC and PathWays populations
Educate and network with people of diverse backgrounds and cultures
Report feedback from the field to further develop and enhance UHCCP programming
Minimum Qualification, Training, and Experience:
Five or more years of education and/or experience in the health services field, with a preference for a candidate who is a
Certified Community Health Worker preferred
Valid Indiana driver’s license required
Reliable transportation required
Travel up to 75% of the time within assigned territory
Willing to work a flexible 40-hour week, including evenings and weekends
Able to transport, lift, carry and set up promotional materials
Smartphone capable of installing Microsoft Office, Zoom, SalesForce, Google Drive, Slack and others, as necessary
Basic computer skills and knowledge of office programs, with the ability to learn new ones
Experience in outreach and linking the community to local resources
Able to deliver presentations and conduct meetings
Flexible to adjust job responsibilities as the position evolves
Contract Sep 30, 2024 Call Center Professional Management Enterprises is seeking a Customer Care Representative to join our call center team! As a Customer Care Representative, you will act as a trusted advisor and educator on health care related inquiries. You will guide our customers to a better healthcare experience, working every day to make healthcare easy with the service you provide.
Job Title: Customer Care Representative
Location: Fort Wayne, Indiana (Remote)
Pay: $16.50 (Weekly Pay)
Work Hours: Monday-Friday, 10am - 6:30pm
Duties and Responsibilities:
Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
Analyzes problems and provides information/solutions.
Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.
Thoroughly documents inquiry outcomes for accurate tracking and analysis.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Researches and analyzes data to address operational challenges and customer service issues.
Provides external and internal customers with requested information.
Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature.
Uses computerized systems for tracking, information gathering and troubleshooting.
Requires limited knowledge of company services, products, insurance benefits, provider contracts and claims.
Seeks, understands and responds to the needs and expectations of internal and external customers.
Required to meet department goals.
Skills:
Experience in customer service is a plus
Bilingual (Burmese/English)
Ability to navigate multiple computer screens at a time.
Ability to provide quality customer service while multi-tasking is a plus.
Requirements:
Requires a HS diploma or equivalent; up to 1 year of previous experience in an automated customer service environment; or any combination of education and experience, which would provide an equivalent background.
Must have a private area to work closed off from others.
Can not be responsible for minors or be a primary caretaker for another person during working hours.
Contract Sep 26, 2024 Other Area(s) Outreach Resources: Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.
Job Description
The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:
Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care.
Utilize a whole health approach when interacting with Members and caregivers.
Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action.
Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings.
Pivot priorities as necessary month to month based on HEDIS performance.
Engage member in care coordination and case management as necessary.
Educate member on health care benefits and services and monitor for over and/or underutilization.
Requirements:
Community Outreach Experience preferred
CHW Certification and/or CNA/HHA preferred
Driver’s License required
High School Diploma/GED required
Contract Sep 26, 2024 Healthcare PME is actively seeking a CNA FT/PRN to assists with nursing programs as assigned. Performs a variety of tasks associated with the daily care and treatment of patients.
Job Responsibilities:
Administers and documents authorized medications and treatments per hospital policies and procedures.
Carries out or assists with physical care of patients including bathing, feeding, taking vital signs, heights, weights, and other activities of daily living as indicated.
Maintains current CPR and Bridge Building certifications.
Escorts patients to and from therapies, and other areas of the hospital for treatment and programming.
Escorts and/or drives patients to off-ground appointments and activities.
Observes patients’ physical condition and reports changes to the RN.
Appropriately and accurately reports pertinent information, both verbal and written.
Appropriately applies skills in psychosocial care of patients: Encourages patients and interacts with them to socialize and participate in activities and programming.
Job Requirements:
High school diploma or GED Equivalent
Successful completion of a Certified Nursing Assistant program
Basic computer skills are required.
Maintain current CPR.
Bridge Building certification.
Contract Sep 16, 2024 Administrative Title: Quality Analyst
Location: Indiana
Hours: Monday-Friday 8am-5pm
Pay: $19.50hr **weekly pay**
Job Description
• Responsible for activities involving quality assurance and compliance with all applicable company and regulatory requirements.
• Adheres to the QMMP (Quality Metric Management Plan).
• Conducts quality performance audits by evaluating trainee output.
• Reviews/analyzes data and documentation.
• Provides analytical reports and makes process improvement recommendations.
• Implements key process improvement efforts and influences cross-functional efforts.
• Assists in the development of systematic approaches for assuring high quality services.
• Provides feedback based on approved process documentation to improve key activities of the organization.
• Some travel may be required.
• All other duties as assigned.
• Completing SPR’s for the Indiana Eligibility Project trainees.
Requirements
• Extensive knowledge of the Indiana Public Assistance Programs (Supplemental Nutrition Assistance Program (SNAP), Medicaid, and Temporary Assistance for Needy Families (TANF) policy and guidelines including IEDSS online help.
• Experience using IEDSS.
Education and Experience (Preferred)
• Associate degree.
• Typically requires a minimum of 1 year of Indiana Eligibility Case Processing.
• Ability to synthesize and analyze complex information.
• Strong ability to read and interpret written information.
• Strong oral communication and group presentation skills.
• Clear and professional written communication.
• Proficiency in Microsoft Applications (Word, Excel, Outlook).
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract Sep 5, 2024 Healthcare Outreach Resources: Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.
Job Description
The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:
Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care.
Utilize a whole health approach when interacting with Members and caregivers.
Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action.
Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings.
Pivot priorities as necessary month to month based on HEDIS performance.
Engage member in care coordination and case management as necessary.
Educate member on health care benefits and services and monitor for over and/or underutilization.
Requirements:
Community Outreach Experience preferred
CHW Certification and/or CNA/HHA preferred
Driver’s License required
High School Diploma/GED required
Contract Sep 3, 2024 Other Area(s) RN Case Manager to conduct UAS Assessments to support care management. The position will be a field position in Syracuse, Albany or Orange, NY. Schedule will be M-F 8:30AM-5PM. ***MUST be RN UAS Certified. Bilingual in any language is highly preferred.
Essential Functions/Responsibilities:
UAS Certified RN licensed in the state of NY.
Conduct face to face assessments of members’ functional status, medical, behavioral, psychosocial and community resource needs.
Provides the Interdisciplinary Care Team (ICT) with assessment information and acts as facilitator to ensure that members’ needs are met.
Develop an ICP/PCSP based on members’ clinical, behavioral, and social needs that addresses barriers to care.
Competently assesses members’ health status and ensures that member is receiving all necessary medical and supportive services.
Manage care transitions through effective and timely communication necessary for member care and discharge planning.
Clarifies SWH plan medical benefits, policies and procedures for members, providers and community-based agencies.
Maintain a comprehensive working knowledge of community resources, payer requirements, and network services for target population.
Required Education:
Bachelor's Degree (a combination of experience and education will be considered in lieu of degree).
Required Licensure/Certification:
NY State RN License in good standing. Contract Aug 19, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract Aug 19, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract Aug 17, 2024 Healthcare The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
• Resident of Indiana
• BSN with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law. Contract Jul 29, 2024 Other Area(s) Senior Care Manager to assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care. The position is fully remote but may require onsite quarterly meetings. The schedule is M-F, 8:00am-5:00pm.
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team.
Reviews member data to identify trends and improve operating performance and quality care.
Reviews referrals information and intake assessments to develop appropriate care plans/service plans.
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources needed to address member's unmet needs.
Education/Experience:
Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing
4 – 6 years of related experience.
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required