Bilingual Assessment Center Case Manager

HealthSpring, Inc. is seeking an experienced Assessment Center Case Manager.


The Assessment Center Case Manager assesses members with high-stratification chronic and/or complex care for referral into disease management program(s), case management, and other interventions needed for coordination of clinical care and/or appropriate socio-economic needs. Other duties include determining which, if any, disease management program(s) is most appropriate for the member and supporting provision of high quality, cost effective clinical care through understanding of internal and external disease management and case management processes at each health plan.

Responsibilities include:
? Identify disease and case management referral opportunities for high-stratification members.
? Communicates directly with member or member?s representative to further evaluate member?s health and/or socio-economic needs.
? Ability to relate telephonically to member or member representative.
? Utilizes departmental software, documents, forms, questionnaires, surveys, and other tools to assess member(s) needs.
? Coordinates member referrals to disease management programs and case management when both and/or multiple disease management programs are appropriate.
? Maintains active knowledge of disease management programs at each health plan.
? Works closely with NewQuest and health plan staff including disease management, case management, enrollment, medical directors, etc.
? Interfaces with disease management, case management, other health plan and NewQuest staff, and external vendors/customers to facilitate effective communication, referrals, and follow-up.
? Communicates with pharmacy department on any identified pharmaceutical issues to include non-formulary medications.
? Provides communication to/coordination with providers and appropriate health plan personnel to facilitate member access to care.
? Works closely with Assessment Center Specialist(s) to coordinate communication, documentation, and follow-up with members, NewQuest/health plan staff, PCPs, and other internal and external customers.
? Understands basics of health risk assessment process.
? Serves as clinical internal support for health risk assessment team and provides clinical guidance where appropriate.
? Provides guidance as needed for referrals on non-standard medium and low stratification members.
? Works closely with medical director(s) and disease management physician champion(s) on clinically complex issues.
? Attend and actively participate in team and other meetings as required.
? Understand and follow Health Services and Assessment Center policies and procedures.
? Assists in creating new and/or reviewing/modifying existing departmental documents, forms, questionnaires, and other tools for health assessment, referral, follow-up, communication, etc.
? Assists in the review and monitoring of assessment center operations including support of development of process and quality metrics.
? Communicates with the Director, Disease Management, NewQuest to resolve issues and/or document trends.
? Assists in data collection, database management, and report compilation.
? Ability to learn and use various software packages, email, and web-content technologies.
? Other duties as assigned.REQUIREMENTS

? Current licensure as a registered nurse in the state of Tennessee.
? Two (2) years experience in an acute care environment
? Two (2) years recent experience in case management, disease management, and/or utilization management.
? Certified Case Manager preferred.
? BSN degree preferred
? Advance certifications preferred
? One (1) year recent experience in management of diseased populations preferred. Bilingual Spanish/English strongly preferred

HealthSpring/Nashville offers a competitive salary and a full range of benefits.



For more information and to complete an online application, please visit our website at www.myhealthspring.com.

 

Everyone must complete an online application.


HealthSpring, U.S.A. is an EEO/AA employer.