Job: RN Telephonic Case Manager

Jobing Description

Requisition #: 3056
Job Title: RN Telephonic Case Manager
Full Time/ Part Time: Full Time

Hours Per Week: 40
Salary Target: negotiable
External Job Description: APS Healthcare provides health services to our member populations, with the goal of improving the health of those we serve. We have an exciting opportunity for a RN Telephonic Case Manager based in our Mechanicsburg, PA office.

The ACCESS Plus Program is a primary care case management (PCCM) system that features a medical home a designated Primary Care Provider (PCP) for each ACCESS Plus Enrollee in the 42 county ACCESS Plus area. ACCESS Plus is an enhanced PCCM program, delivering greater value to Enrollees, Providers, and the DPW. These enhancements are designed to improve access to appropriate primary, specialty, dental, and behavioral healthcare for the program Enrollees.

Summary:
The RN Telephonic Case Manager provides telephonic outreach, case management, education and support to plan Enrollees to support healthy lifestyle choices & to reduce short and long term effects of complex, chronic illnesses. This individual performs other clinically based activities to coordinate care between the Enrollees, physical and behavioral health providers and community based resource and health organizations.

The Case Manager supports the Supervisor in executing the overall vision, mission, and goals for the organization and specific state/contract requirements. The Case Manager additionally focuses on the consistent adherence to key workflows, policies, and related duties to support the daily operation and delivery of health services.

This individual supports a positive team atmosphere by working collaboratively and providing daily support of new and existing employees. The Case Manager effectively delivers ongoing care and service in alignment with federal and state regulatory requirements and scope of practice for clinical position. The Case Manager collaborates and interacts closely with the telephonic supervisor and manager in addition to the other operational teams.

Essential Functions:
FINANCIAL: Assists Supervisor and Manager in ensuring achievement of contractual financial obligations, including service delivery in a cost effective and efficient manner and through support of budgetary adherence by reporting accurate and timely work hours and expenses incurred during course of position duties.
OPERATIONAL: Ensures the responsible and professional delivery of comprehensive service and care delivery of the case management program with a focus on complex cases and coordination with community resources. Conducts assessments, develops action plans and associated interventions and sets goals for behavior modification within the scope of practice. Implements future-oriented plan of care, focusing on enrollee s goals and interventions that support improvements in health and overall self-management of the enrollee s specific disease state(s). Identifies barriers to successful care planning and evaluates and implements effective options for enrollee s receiving case management services. Continuously delivers position responsibilities in alignment with staff productivity and performance expectations and documentation standards. Effectively and efficiently utilizes available telephony and medical management applications and supportive data to complete various aspects of position responsibilities. Collaborates and problem-solves with peers and management team on operational and performance issues. Attends required educational training programs and implements knowledge gained into daily activities. Develops strong working relationships with management, peers, enrollees, providers and community resource organizations to support programmatic delivery.
CORPORATE CULTURE: Promotes mission, vision and values of APS Healthcare. Demonstrates ownership of position and proactively carries out position duties with limited direction and/or oversight. Achieves Certified Case Management (CCM) designation within first eighteen (18) months of employment in position and/or maintains CCM certification throughout employment in position. Maintains professional licensure(s), certification(s), and completes required continuing education credits to support ongoing position requirements. Promotes and facilitates positive team atmosphere by demonstrating the ability to work within a team and support team efforts, as well as sharing knowledge with peers and other team members.
QUALITY/SATISFACTION: Proactively engages in delivery of quality management program activities that are the direct responsibility of the Health Services telephonic team. Assists in the achievement and ongoing maintenance of URAC and NCQA accreditations for defined programs. Demonstrates and facilitates customer service excellence. Meets benchmark performance metrics for monitoring activities. Communicates pertinent information and or potential quality issues identified during daily activities to supervisor in accordance with corporate and departmental policies.

Education:
Associates Degree in Nursing required.
BSN/MSN preferred.
Current, unrestricted RN licensure in PA required.
Certification in case management (CCM) required, or other clinically relevant designation such as chronic care professional (CCP).

Qualifications:
Minimum 3 years of recent acute clinical experience and/or 3 years demonstrated experience as a case manager or related position, e.g. disease management, population management, etc.
Knowledge and familiarity with public sector health coverage payment systems, e.g. Medicare / Medicaid.
Knowledge of principles, ethics, and precepts of care management service delivery.
Knowledge of customer service principles.
Understanding of adult learning and behavior change principles preferred.
Knowledge of regulatory and accreditation standards.
Knowledge of national clinical practice guidelines related to clinical program delivery.
Strong written and verbal communication skills.
Strong telephonic interviewing and assessment skills.
Strong operational and performance management skills.
Solid computer skills, e.g. care management applications, Internet/Web, Microsoft Office (Word, Excel, Access).
Strong prioritization and organizational skills.
Ability to demonstrate purposeful and outcomes directed critical thinking within daily operational activities of care management delivery using sound judgment and facts in carrying out case management activities.
Ability to receive verbal and written feedback in a professional manner and implement performance and productivity improvements as needed
Ability to interpret real-time and historical information to inform delivery on overall accountabilitie

Country: U.S.

State: Pennsylvania

City: Mechanicsburg