Disease Case Manager

Responsibility for the Health Resources Department?s planning, implementation, oversight and evaluation of chronic disease management programs, which includes but is not limited to, asthma, diabetes, CHF, Hep-C and Hypercholestremia. 

 

RESPONSIBILITIES:Manage all aspects of current and future Disease Management programs.Conducts post-discharge physician and member phone calls to assess and manage re-admission risk related to targeted chronic/serious disease states.Refers cases to Medical Director after discussion with the Director of Health Resources when issues and concerns regarding the appropriateness, quality, or efficiency of care delivery are identified.Coordinates High Risk and Normal Pregnancy identification through claims reports to identify and follow up with our maternity membersDocuments and tracks risk management findings, actions, and outcomes.Collaborates and communicates with network providers and community-based resources to arrange appropriate follow-up care and services for plan members.Educate members, families, and providers regarding health care alternatives and applicable benefits.

 

QUALIFICATIONS:RN or LPN with current license.3+ years clinical experience in a hospital, community or managed care setting.Ability to identify and prioritize member needs and provide structure and focused interventions.Excellent telephonic communication skills for rapidly and effectively building relationships with patients.Working knowledge of community based resources and services.Excellent time management and prioritization skills.Experience and evidence of relevant study in the areas of chronic disease management. 

 

In exchange for your talent and expertise, we offer an extensive benefit package and a highly competitive salary structure.