Case Manager

Job Summary  

The Case 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 Case Management Certification. 

• Continuing education in 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 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 information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.