Disease Management Case Manager

HEALTH PARTNERS, a growing, progressive Managed Care Organization serving the Medicaid and Medicare population in Philadelphia and surrounding counties seeks Disease Management Case Managers to join its Healthcare Management Team.  We offer excellent benefits, competitive salaries and a great 401(k) Plan.

 

GENERAL DESCRIPTION:  Ensure that comprehensive, quality, cost effective patient care is offered for members with select chronic illnesses.  Review medication profiles, verify appropriate testing, and facilitate office visits with primary care and specialist physicians.  Coordinate with hospital case managers to ensure continuity of care and outpatient services when medically appropriate. Perform outreach, education, and follow-up to members in Disease Management programs. 

 

KEY REQUIREMENTS:  Licensed Registered Nurse, or LPN with two years? experience.  Must have an active license to practice professionally in the Commonwealth of Pennsylvania.  Experience including medical/surgical, emergency room, homecare/DME authorization, preferred.  Must present polished professional image.  Understanding of HMO health care delivery systems.  Ability to work and communicate effectively with co-workers, members, and providers at the owner institutions.  Must be organized, detailed oriented, and capable of handling multiple issues.  Excellent telephone and verbal/written communication skills.  Computer literate.  Disease Management experience a plus.

 

PRIMARY RESPONSIBILITIES:  Review and track cases initiated from outreach coordinator to outreach targeted individuals.  Assist primary care provider offices in coordinating care of members for Disease Management programs.  Track assigned cases for timely interventions and trend for DM outcomes.  Regularly collaborate to evaluate and improve DM programs to ensure appropriate medical management.  Function as a liaison between case managers, pharmacy, DM delegates, utilization management, hospitals, providers, and members.  Stratify members for disease management and promote successful outcomes.  Serve as resource for physicians, PCPs, Utilization Management departments and all medical providers. Outreach Medicare members for care coordination in accordance with Medication Therapy Management Program guidelines.  Work collaboratively within the Health Care Management department on tasks as needed.  Refer appropriate cases to departments within Health Care Management to assist with quality of care and utilization management.