Temporary Case Manager

JOB SUMMARY:Assist members in navigating the health care system, ensuring access to evidenced based care. Educate, empower, and coordinate services for members to improve their health and well being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.ESSENTIAL JOB FUNCTIONS:Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions. Conduct telephonic or face to face health assessments to identify high risk or emerging risk members who would benefit from education and intervention. Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans aimed at improving the members’ total health.Identify opportunities to impact claims expense trends for the all lines of business/or at the individual member level.Evaluate action plans by working with members, and collaborating with providers. Modify action plans as necessary.Monitor and evaluate patient services to ensure appropriate coordination of care. Collaborate with the Utilization Review process including pre-authorization, concurrent review, screening cases for quality of care issues, and discharge planning. .Promote member and provider satisfaction by demonstrating working knowledge of member benefits, including but not limited to health, disability, Employee Assistance or other plans/benefits available to the memberProvide continuity and consistency of care by building positive relationships between the member and family, physicians, provider, care coordinator, and health care plan.Work collaboratively with the team and others necessary to develop and implement solutions. Identify barriers to performing job duties as well as opportunities for improvements. Exemplifying the corporate values in action through accountability, collaboration, integrity and respect in maintaining a high performance culture.Participate in department initiatives and projects.Perform other duties as assigned. QUALIFICATIONS:Minimum Education and Experience:Associate’s degree in Nursing or related field; or an equivalent combination of education and experienceUnrestricted Rhode Island Nursing License and Unrestricted Massachusetts Nursing License, or unrestricted Registered Dietician LicenseThree to five years experience in a medical/clinical environment or managed health planMust obtain Certified Case Manager (CCM) certification within three years of employment*Applies to positions working with FEP product onlyPreferred Education, Additional Qualifications and Experience:Bachelor’s Degree in NursingProfessional nursing certificationExperience working in a managed care/health maintenance organizationMultilingualRequired Knowledge, Skills, and/or Abilities:Knowledge of utilization management and/or coordination of careKnowledge of population health and chronic condition management principlesUnderstanding of health care delivery system access points and servicesAbility to navigate the healthcare delivery systemGood business acumenKnowledge of business process improvement techniques and strategiesExcellent verbal and written communications and technical skillsNegotiation skillsPresentation skillsDecision-making skillsGood problem solving skillsAbility to interface with employees at all levelsAbility to effectively navigate ambiguous situations with limited directionExcellent organizational skills and ability to successfully prioritize multiple tasksAbility to handle multiple priorities/projectsStrong time management skills