Care Manager
Location: Boston Massachusetts
Description: Neighborhood Health Plan (NHP) is hiring Care Manager right now, this occupation will be placed in Massachusetts. Detailed specification about this occupation opportunity kindly see the descriptions. Summary:
Neighborhood Health Plan (NHP), located in Boston, is currently seeking three experienced, highly skilled Care Managers.
The care manager (CM) will use clinical and CMSA standa! rds to provide care management to NHP members on an ongoing basis, within the members benefit package. The CM will initiate and maintain communication with members, Primary Care Physicians and other health team members regarding care management plans to collaborate to meet members’ needs. The CM is responsible for conducting outreach, assessment, and care coordination/management for identified Neighborhood Health Plan (NHP) members. The CM works closely with other medical care managers, social care managers and behavioral health care managers, and other Neighborhood Health Plan departments to ensure quality and effective service and support to members.
Responsibilities include conducting standardized assessments on all high-risk members including those identified through the Health Needs Assessment (HNA) process, enrollment and trigger reports, and other case identification sources, and establishing and implementing culturally competent care management plans to m! eet the needs of members.
Primary Responsibilities! :
Complete comprehensive assessment of the medical and psychosocial needs of members and their families for all products, including Medicare, Medicaid, Commercial and Connector products
Create patient centered and culturally competent care management plans to include problem identification, goal-setting, interventions and expected outcomes
Facilitate and coordinate the appropriate services and supports to meet the needs of NHP members, particularly high risk populations.
Educate members related to health care conditions and treatment plans with a focus on medication adherence, appropriate use of emergency room, and navigation of the health care system
Collaborate with social and behavioral health care managers and Pharmacy to develop a comprehensive and integrated approach to care coordination.
Participate in rounds forums to promote integrated case discussions and problem-solving
Make timely referrals to the community model for complex care ! management
Document care management activities in NHP’s care management system according to established protocols
Document utilization management activities in NHP’s utilization management systems and tools according to established protocols
Complete care and utilization management activities in a timely manner and meet compliance requirements for the Division of Insurance, MassHealth, Medicare, NCQA, and Clinical Services Department standards.
Demonstrate flexibility and creativity in order to achieve maximum effectiveness and optimal outcomes for members and their families.
Participate in member/family meetings to support integrated efforts and collaboration with the health care team
Provide assistance, advocacy, and empowerment to members in efforts to achieve optimal health
Serve as a mentor/preceptor for new staff
Serve as a resource for the integrated CM teams, Clinical Department, as well as other NHP departments, including partici! pation in presentations and activities
Anticipate, and meet or exce! ed internal and/or external customer expectations and requirements; establish and maintain effective relationships with customers and gain their trust and respect.
Preferred Qualifications:
Valid Unrestricted Massachusetts RN or other Health Care professional license
Certified Case Manager (CCM) or other comparable certification
Bachelor’s degree in nursing or other allied health field, Masters a plus
3-5 years acute care or program-specific population/disease expertise
Care management experience
Experience in Managed Care, Home Health Care
Exposure to Medicaid and Medicare
Core Competencies:
Excellent verbal and written communication skills
Demonstrated ability to multi-task
Works with minimal or direct supervision
Ability to work independently and in teams
Demonstrated creativity in formulating care plans from assessment and clinical information
Use of evaluative and outcomes data to imp! rove ongoing care management services
Promotion of health care outcomes in concert with currently accepted clinical practice guidelines
Adherence to the code of ethics for the care manager’s professional discipline
Development and maintenance of collaborative, proactive and patient focused relationships to maximize client health care outcomes
Strong internal and external customer orientation and focus
Ability to build collaborative working relationships with practices and facility personnel
Demonstrated commitment to member advocacy
Participation in work groups and other activities to enhance care management
Participation in quality improvement initiatives within the Clinical Operations Department
Competency with Windows based systems, Microsoft Office applications and web-based searches
Competence in or ability to learn NHP care and utilization management systems and tools
Demonstrates NHP Core Values of Service Excellence, Qua! lity Care, Diversity, Responsibility and Relationships.
Respects th! e talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner.
Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
Accountable for delivering high quality work.
Care Management practice will be guided by ethical principles
All activities will be conducted in compliance with HIPAA Privacy Regulations
NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, paid time off, commuter benefit, and a generous employer contributed retirement program.
NHP's mission targets a diverse population and our employees are just as diverse. As an equal opportunity employer, NHP recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds
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If you! were eligible to this occupation, please email us your resume, with salary requirements and a resume to Neighborhood Health Plan (NHP).
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Fri, 04 Oct 2013 04:06:52 GMT