Telephonic Case Manager - Nurse

The Telephonic Care Manager is part of the ilumed clinical team, providing a comprehensive, holistic approach for Case Management /Disease Management programs throughout the continuum of care. The Telephonic Case Manager acts as the beneficiary’s advocate. They assess, plan, implement, coordinate, monitor, and evaluate the available options and services to achieve optimal capacity for beneficiary self-care to enhance quality of medical care and achieve the desired optimal clinical outcomes.

Essential Job Functions

  • Provide telephonic care guidance support to beneficiaries and their family/caregiver to ensure education, care coordination and support measures are in place, in accordance with the established plan of care.
  • Coordinate and collaborate within the Care Management programs, physicians or providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions, documenting interventions and outcomes for beneficiaries within the Care Management program.
  • Utilize Motivational Interviewing and solution-oriented approaches in communication delivery.
  • Identify Social Determinants of Health needs and/or community resources to provide services
  • Maintain beneficiary’s privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
  • Participate in professional development activities to include current principles, procedures, and knowledge domains of case management based on nationally recognized standards and licensure requirements.
  • Performs all duties within the scope of his/her licensure.
  • Other duties as requested.

Knowledge, Skills and Competencies

  • Proficient with Microsoft Office Excel & Word
  • Excellent communication skills; verbal and written, and organizational skills

Education and Experience

  • Active Social Worker license in state of employment or Case Management Certification (CCM)
  • 2-4 plus years managed care experience

Physical Requirements

  • Prolonged periods of sitting at a desk and working on a computer.

Additional Information

  • Must abide by all HIPAA, Confidentiality & Privacy Laws
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

DISCLAIMER:

Job descriptions are not meant to be all-inclusive and/or the job itself is subject to change. Nothing in this job description restricts ilumed’s right to assign or reassign duties and responsibilities to this job at any time.

One or more fields have an error. Please check and try again.