Company Name Withheld
Note: this position has the ability to work remotely until further notice!
The current healthcare landscape is ever-changing, but the desire to provide patients with better, more affordable care is consistentHealthcare providers are working to evolve and support population health management and today’s value models, but there is still uncertainty in the marketProviders need a proven, integrated approach that takes the best of today’s technology and matches it with deeply experienced professionals.
Innovista health solutions is an illinois-based service organization with management services operations in illinois and texasWe are currently looking for a clinical case manager out of our southeast texas officeAt innovista, we believe that positive forward movement in today’s uncertain healthcare market stems from the combination of innovative programs and dedicated peopleJoin the innovista team and lead the charge to a better, more efficient healthcare system.
The role of the clinical case manager is to coordinate continuity of care for patients often as a liaison between the patient’s family and healthcare organization, ensuring that the proper treatment is administered at the appropriate time to maximize health and well-being while also minimizing the need for hospitalizationThe case manager strives to promote self-managed care and the use of healthcare resources in the most cost-effective way possible, working with patients of all ages and conditions, but primarily focusing on a specific populationThe individual in this position has overall responsibility for overseeing the clinical care plan to conform to evidence-based practice and regulatory requirementsThis position integrates care coordination, utilization management, and discharge planning.
Duties and responsibilities:
Implements a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.
Identifies members appropriate for case management by use of targeted chronic conditions, level of care, and recognition of member’s condition specific and preventative measures, knowledge base or deficits in monitoring health, wellness and chronic conditions.
Provides transitional care management, coordinating post-hospital care to prevent readmissions.
May perform on-site and telephonic continued stay review on members at predetermined interval during facility stays to collect in-depth information regarding the member’s situation, functioning, needs assessment in order to develop a comprehensive medical management plan and discharge plan.
Determines appropriate level of care and place of service based on medical information available and criteria application.
Collaborates with medical director when appropriate (i.e., communicates review findings, criteria not met, use of alternative care settings, determination of appropriate level of care, delay of provision of services, etc.) to insure appropriate, coordinated service delivery.
Identifies members requiring post hospital services and initiates discharge planning with attending physician and designated hospital personnel.
Coordinates appropriate post hospital services.
Collaborates with the provider or their designee to address the care plan from an integrated approach.
Implements, monitors and closes the care plan to determine if the goals are being met on an ongoing basis to evaluate for needed changes and updates the plan of care accordingly.
Conducts outbound calls to members to complete telephonic assessments and provide interventions and education for the management of member’s health, wellness and chronic conditions.
Reviews and analyzes clinical indicators and whether there is any ‘gap’ in compliance with quality of care.
Identifies and reports quality of care issues to the medical director and the director of population health management.
Completes clear and concise documentation in care management programs.
Prepares, participates and presents cm/dm reports to um/qm committee as requested.
Collaborates with the internal staff to support and uphold the established guidelines and ncqa standards.
Maintain personal professional development within clinical expertise.
Participate in departmental and company in-services, meetings and/or conferences as appropriate
Performs other duties as assigned.
Bachelor’s degree or equivalent experience required
At least 3-4 years of relevant professional experience.
Registered nurse (rn), licensed clinical social worker (lcsw), or licensed master social worker (lmsw) with a current and active nursing or social worker license to practice in the state assigned required.
Certified case manager (ccm) preferred.
Knowledge of disease pathophysiology, psychosocial issues, and treatment
Demonstrate excellent organizational skills.
Demonstrate effective verbal and written communication skills.
Demonstrate analytic skills when problem solving.
Proficient in ms office applications and ability to learn department and job specific software systems.
Demonstrate high attention to detail and a high degree of accuracy.
Able to commit to innovista’s corporate mission and values.
Able to switch priorities in a positive and effective manner when directed by company leadership.
Able to effectively communicate case management concepts with team members and clinical concepts and program outcomes with team members and internal customers.
Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor.
Innovista is dedicated to hiring passionate individuals who embody our core values: integrity, determination, and teamworkWe recognize the importance of work-life integration and seek to provide our employees with competitive benefits, which include:
Comprehensive health plan options, dental, and vision coverage subsidized by innovista
Opportunity to work from home, based on position and manager discretion
Company-paid benefits, such as short- and long-term disability, employee life, and ad&d
401(k) with company match
Opportunity for career advancement and growth
Flex time options may be available
Please note: we do not post salary rangesSalary ranges posted on other sites are not tied to our labor market specifications and are not relevant.