Care Manager

Premier Health Network, LLC We Are InnovaCare! InnovaCare Health is a dynamic physician lead healthcare provider pioneering change in value-based healthcare. We operate 40 clinics with 1,100 employees who share the mission, vision, and values that drive success in each of the communities we touch. Our goal isn’t just healthcare; it’s about promoting work-life balance and supporting the personal and professional goals of each employee to help them lead their best lives. We are an organization strengthened by our diversity and inclusion. We strive to make an impact in the community through public health education, outreach, and our philanthropic endeavors that span beyond the doors of our facilities. As we continue to grow, we want employees, like you, who value improving the lives of those they care for each day. #WeAreInnovaCare Our practices offer: Women’s Health, Wellness, X-Ray/Ultrasound, Dental, Chiropractic, Urgent Care, Managed Care, and Workers Comp services InnovaCare Health at Orlando Family Physicians is a leading healthcare provider in Central Florida. We are committed to providing our patients with the highest quality care possible through comprehensive medical services and cutting-edge technologies. We are a team of passionate professionals who are always seeking top talent to join us. We offer a supportive and challenging work environment where you can grow and thrive. Job Summary The OFP Care Manager (CM) position is responsible for promoting patient quality of care and cost-effective outcomes by the process of assessment, planning, facilitation, care coordination, and the evaluation of comprehensive health needs. The CM position collaborates with clinical staff inside and outside of the InnovaCare organization and the contracted insurance companies. Essential Job Functions Utilize clinical tools, data, and other information to complete patient needs. Create individualized and comprehensive needs assessment for care management and treatment plans. Document all treatment plans, tasks, and actions into EMR when applicable to meet turnaround times as documented in policy and procedures. Collaborate with Utilization Management (UM) staff in transition of care protocols to avoid readmissions and focus on meeting all CMS STAR measures for transition of care (TOC) and Medication Reconciliation. Clearly validate prescribed treatments and treatment plans to patients to follow. Educate patients on available support services: social work programs, insurance company services and benefits along with other community resources to meet social determinates of health (SDOH) needs. Collaborate with patients, providers, and insurance companies for successful healthcare outcomes and to manage chronic and high-risk conditions. Document accurately complex medical information that outlines and demonstrates how to improve health results along with educating patients on Advanced Directives. Responsible for on-going monitoring and evaluation of patients. Follow care and quality management processes in compliance with regulatory guidelines and company procedures. General Knowledge/Skills Must: Critical thinking and problem-solving skills. Preferred: Clinical knowledge of chronic conditions, management of high-risk patient populations and knowledge of available community resources. Strong knowledge of managed care concepts. Strong written and verbal skills with patients, physicians and other stakeholders including techniques in facilitating patient engagement in their healthcare. Demonstrate ability to timely assess and respond to patient and family needs. General knowledge of care (case) management practices, including familiarity with Medicare Advantage products, programs, and services. Experience in establishing professional and collaborative relationships with patients, providers, and insurance organizations. Basic computer skills, including working knowledge of the Microsoft Office suite. Not required, but preferred: Certification as a diabetes educator, nutritionist or social worker or other specialty. Minimum Required Education, Experience & Skills Current Nursing License within the state in which you work or Compact License, RN preferred, may consider LPN with Managed Care experience outside of clinical setting. Minimum two years clinical practice, one (1) year care (case) management experience or will work towards and maintain a Care (Case) Management Certification. Continuing education in Care (Case) Management and all other applicable professional licensure. CPR/BLS certification. ENVIRONMENTAL AND WORKING CONDITIONS In this position, the employee will work in an office setting that requires sitting, walking, talking, and listening. Position will require a valid driver’s license and will travel approximately 30% of the time. Physical & Mental Requirements: (check all that apply) Required immunizations and vaccinations. Ability to lift to 50 pounds. Ability to push or pull heavy objects using up to 100 pounds of force. Ability to stand or sit for extended periods of time. Ability to use fine motor skills to operate equipment and/or machinery. Ability to properly drive and operate a vehicle. Ability to receive and comprehend instructions verbally and/or in writing. Ability to use logical reasoning for simple and complex problem solving. Occasionally requires exposure to communicable diseases or bodily fluids. Occasional travel for clinic activities may be required (ex. InnovaCare meetings or training). The foundation for InnovaCare was laid in 1998 when President and CEO Richard Shinto, M.D., founded North American Medical Management (NAMM) in California. Since then, InnovaCare Health has continuously evolved and innovated to remain at the forefront of healthcare and deliver cutting-edge solutions to our physicians and team members, patients, and their families. Across InnovaCare, we are united by a shared mission, vision, and values. Our growing company strives to make every member of our diverse team feel fulfilled and valued through their work. Our mission is to transform the lives of the people we serve through compassionate, high-quality care, innovative solutions, and trusted partnerships as we vision a new definition of the standard of excellence in healthcare. Today, InnovaCare operates more than 30 clinics and is recognized as a leader in transforming care delivery. Our approach combines physician-led care models with cutting-edge technology and a focus on personalized, coordinated care to empower providers to succeed in some of healthcare's most challenging environments.