The majority of our roles will continue working from home through September. Once campus restrictions begin easing in October, we will continue to encourage employees to take a virtual-first approach to their work when possible. As long as job responsibilities are not impacted, being in the office full-time will not be necessary or expected. During the interview process, our Talent Advisors will walk through our virtual-first approach and will answer questions you may have.
Additional Locations:
Job Description
The Case Manager / Health Coach coordinates the care and services of selected member populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes.
Serve as a team member on a multidisciplinary team that monitors utilization patterns; identifies and facilitates appropriate health care service delivery for selected members, providers, procedures, and/or diagnoses; and improves the quality and cost efficiency of care and service.The application of the Case Manager or Health
Coach's knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.
Core functions include:
Outreach
Outreach to members identified as high risk, high cost, or high utilization cases.
Encourage pro-active intervention to limit expense and encourage positive outcomes.
Assessment
Perform a comprehensive assessment of the member's health status, educational, and level of support needs.
Planning
Develop a member-centric care plan which includes a self-management plan tailored to member's needs, and identification of barriers to meeting goals or plan of care.
Utilize community resources and funding sources in the development of the plan of care.
Monitoring
Perform ongoing monitoring and management of member including: scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
Evaluating
Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care).
Review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
May evaluate medical necessity and appropriateness of services as defined by department.
Documentation
Document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
Complete all correspondence related to case management, including all calls and faxes with phone and fax numbers noted. Obtain consents as indicated.
Hiring Requirements
RN with Associate's degree or Bachelor of Science in Nursing (BSN).
Minimum of 3 years full-time direct clinical experience in an acute medical or acute surgical setting.
Proficiency with a Microsoft Windows operating system
Must have valid license to practice nursing within the US and have started application for NC nursing license.
