Case Manager, Senior Programs - Portland
Location: Portland, Maine
Description: Martin's Point Health Care is at the momment seeking for Case Manager, Senior Programs - Portland right now, this position will be presented in Maine. Further informations about this position opportunity please give attention to these descriptions. The Case Manager, Senior Programs works collaboratively within the HMD team and across the organization to ensure high quality care, ! service and cost effective outcomes are achieved for the Medicare senior member population. The Case Manager provides expertise to the HMD team for the Martin’s Point Medicare line of business, including the Medicare Stars Program. The Case Manager works collaboratively with the MPHC Health Plan and Delivery System staff to support clinical outreach activities that drive improvement in Medicare star ratings. This position closely partners with the NP, Medicare Quality Programs and Medicare Program Analyst to ensure alignment of activities and appropriate hand-offs between teams.
The Case Manager works with members along the health continuum. Primary responsibilities include implementing strategies designed to facilitate the appropriate use of health care resources while ensuring that each client has the opportunity to reach optimal health status through appropriate, quality care. This is accomplished through extensive coordination of services across the continuum! , assuring appropriate level of care, anticipating future heal! th care needs, decreasing fragmentation of care, and identifying alternative care plans.
The Case Management process is based on both the American Nurses Association (ANA) and the Case Management Society of America (CMSA) standards and includes assessment, problem and need identification, long and short term goals, care management plan, and outcome evaluation, as applicable.
Key Outcomes:
Manages chronic conditions in the senior population, with an emphasis on outcomes aligned with Medicare Stars/Quality measures
Collaborates with Clinical Program Development team to examine clinical programs information to identify and facilitate engagement of members for specific Case Management/Chronic Care/Disease Management activities or interventions by utilizing established screening criteria
Facilitates closure of gaps in care (preventive and clinical), with an emphasis on outcomes aligned with Medicare Stars measures
Collabora! tes with Medicare Nurse Practitioner, case managers (working in the Health Plan and Delivery System), and pharmacists to coordinate member care, both in understanding key messages and ensuring smooth transitions/hand-offs between teams
Serves as the Senior products subject matter expert within the case management team
Participates in Stars work group and coordination of outreach initiatives to close gaps in care
Engages providers in closure of member gaps in care and management of chronic conditions to achieve clinical outcomes
Manages health care within the benefits structures per line of business and performs functions within compliance, contractual and accreditation regulations, e.g. Centers for Medicaid and Medicare, URAC, NCQA, Employer contracts and state insurance regulations as applicable
Completes assigned outreach and intervention plans according patient priority, uses appropriate interventions based on disease state ne! eds and documents actions and outcomes’ according to CM/UM program.
Performs moderately complex analysis of outcomes and trends to help modify program for greater effectiveness. Reviews and analyzes population data and metrics to inform development of programs and improved health outcomes.
Assists in creation and updating department Policies and Procedures
Participates in quality initiatives and process improvements that reinforce best practice medical management programming and offerings.
Education/Experience:
Unrestricted state licensed registered nurse, BSN preferred
Certification in Case Management required; e.g. CCM, ANC or other certification through an organization recognized by URAC/NCQA
5+ (total) years clinical nursing and case management experience implementing, performing and measuring case and/or utilization management activities in a managed care, nursing home/assisted living facility, or hospital environment, strongly preferred
2+ years experience in cas! e managing senior populations required
Knowledge of Scope of Nursing Practice in states where licensed
Skills/Knowledge/Competencies (Behaviors):
Maintains knowledge, and practices within, CMSA Case Management Standards of Care and Code of Professional Conduct guidelines.
Maintains current licensure and practices within scope of license(s) for geographic areas of practice.
Knowledge of evidence based guidelines application.
Ability to analyze data metrics, outcomes and trends.
Excellent interpersonal, verbal and written communication skills
Critical thinking: can identify root causes and understands coordination of medical and clinical information
Ability to prioritize time and tasks efficiently and effectively
Ability to manage multiple demands
Ability to function independently
Computer proficiency in Microsoft Office products including Word, Excel, and Outl! ook
- .
If you were eligible to this position, please emai! l us your resume, with salary requirements and a resume to Martin's Point Health Care.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position will be started on: Tue, 26 Mar 2013 22:46:04 GMT
Apply Case Manager, Senior Programs - Portland Here