Care Management Nurse

5 hours ago

Angeles City, Central Luzon, Philippines MVP Asia Pacific Full time $60,000 - $80,000 per year
MVP Asia Pacific Inc

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Care Management Nurse (WFH, G.Y.)

Job Description:
  • Utilize clinical judgment, independent analysis, critical thinking, time management, and detailed knowledge of the Care Navigation Program to facilitate the coordination of care for patients.
  • Collaborate with clinical and non-clinical staff and other members of the patient's health care team to develop an individual plan of care to facilitate an immediate action plan to meet the patient's current needs.
  • Communicate and coordinate with patients and appropriate members of the patient's health care team in developing, executing, and reviewing results of care coordination efforts.
  • Collect, review, and employ all pertinent medical information available from but not limited to the company's clinical systems, care management notes, hospital discharge information, physician clinical information and patient reported health status.
  • Assess patient conditions, in conjunction with clinic staff, such as the discovery of unreported medical or social conditions or changes at home that may lead to adverse outcomes, and ensure that these are referred to appropriate sources for attention.
  • Execute member Health Risk Assessments to create a nursing care plan.
  • Work with the members on a regular basis to update and maintain the nursing care plan.
  • Practice within the scope of your license.
  • Identify barriers to efficient utilization and facilitate resolution.
  • Collaborate with other departments to resolve claims, quality of care, member, or provider issues.
  • Participate in Inter-disciplinary Care team meetings.
  • Identify problems or needed changes, recommend resolutions, and participate in quality improvement efforts.
  • Maintain and enhance relationships between the business and the provider community.
  • Provide consistent and accurate documentation.
  • Plan, organize, and prioritize assignments to comply with performance standards, corporate goals, and established timelines.
  • Consult with Physician Advisors to ensure clinically appropriate determinations.
  • Work within a team to move the member through the continuum of medical management with the goals of facilitating quality health care through the most cost-effective means.
  • Be responsible for including focus on other departments, but not limited to clinical management teams, when needs arise.
  • Perform on-call duties as needed.
  • Perform other duties as assigned.
Qualifications:
  • Bachelor's Degree in Nursing.
  • US RN (United States Registered Nurse) license.
  • Florida and/or Arizona State licensure.
  • 2 to 5 years of related experience, or equivalent directly related work experience.
  • Previous successful call center, problem-solving, and budgeting experience is a plus.
  • Successful project management experience is a plus.
  • Proficiency in word processing, spreadsheet, database, presentation, and email applications.
  • Ability to collaborate with both clinical and non-clinical team members to facilitate the desired care coordination outcome.
  • Clear and persuasive patient communication skills.
  • Organized and detail-oriented with a strong bias for follow-up and problem resolution.
  • Proven ability to be a team player.
  • Excellent analytical and leadership skills.
  • Excellent verbal, written, and meeting presentation skills.

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