MedWatch, LLC · 1 day ago
Chronic Condition Case Manager / RN
Lake Mary, FL
Full-time
Hybrid
Mid Level
$62K/yr - $74K/yr
3+ years expMedWatch, LLC is seeking a Chronic Condition Case Manager / RN to manage individual caseloads using Complex and Chronic Condition Management constructs. The role involves collecting patient information, guiding patients in their care plans, collaborating with providers, and maintaining documentation.
Clinical TrialsHealth CareMedical
Responsibilities
The Chronic Condition Case Manager will practice within the scope of his/her licensure. Individual must speak fluent English with strong reading and writing abilities
Collect and document patient information to facilitate the initial assessment and formulation of an initial plan of care
Continuously gather, update and review information to include (but not limited to) collecting medical records, history, assessment information
Guide, coach and encourage the patient in following the plan of care. Instruct the participant regarding both short and long-term goals and offer guidance as to how to meet those goals. Document actions taken and interventions provided throughout the process
Collaborate with providers, payers, and participants to ensure that the participant has access to appropriate resources
Contact the payer to determine benefits and any constraints that may impact the plan of care
Contact providers and vendors to verify medical necessity of care or products that have been ordered
Make arrangements for quality care according to the needs of the participant, the physician’s orders and available benefits
Maintain a current up-to-date working knowledge of alternative treatments. If there are no benefits available for recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the participant’s medical condition and will be cost-effective to the benefit plan
Become familiar with community resources or other funding sources that will allow the participant to receive quality care and conserve health benefit dollars
Maintain documentation in the computer system. Complete all aspects of case in the computer
For fee-for-service clients:
Prepare timely reports to the payer to summarize case actions, the results of those actions, and the continuing disease management plan
Maintain billing as appropriate in computer system
Adhere to standards of production goals
Maintain on-going contact with providers and participants to ensure that the participant’s needs are being met
As needed, negotiate with providers to maximize the medical benefits available to the participant. Make network referrals as appropriate
Take actions upon any awareness of non-medical issues which involve the participant’s safety or welfare and attempts to direct the participant or family to appropriate providers or community resources, or to personally notify appropriate authorities
Consult with the Director of Case Management on a regular basis. Keep the director informed regarding any complaints which may occur about disease management services or any issues which arise which the disease manager is not competent to handle or does not have the expertise to handle
Use good organizational skills to manage time and resources efficiently
Use effective writing style to organize information and thoughts and present them clearly and concisely in writing for prepared reports, correspondence, etc
Use effective teaching strategies during contacts with patients by telephone and in selecting appropriate educational materials. Use effective listening techniques to identify where the patient is in their stages of behavior change and respond appropriately
Seek opportunities for personal growth and development. Remain up to date on health and wellness topics as well as current treatment options for chronic medical conditions. Keep abreast of new trends and practices in the field of disease management
Always maintain a professional attitude and approach using tact, courtesy, self-control, patience, loyalty, and discretion to work harmoniously with others. Maintain the ability to adapt to new situations and changing work responsibilities
Adhere to all department and company policies and procedures
Participate in onsite and offsite employee health fairs as needed. Provide individual or group teaching and/or facilitate support groups focused on a chronic disease topic
Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers
The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice
Qualification
Required
Minimum of three years of clinical experience including at least two years of chronic disease management and patient teaching in any setting preferred
Registered Nurse (current unrestricted, in state of practice)
Good keyboarding skills and computer literacy preferably with Microsoft Office applications and with internet
Must be fluent in English
Good organizational skills and time management
Excellent verbal and written communication skills
Ability to handle difficult situations tactfully and diplomatically
Effective problem solving and decision-making skills
Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint)
Company
MedWatch, LLC
Since 1988, MedWatch has been a leader in providing concierge member advocacy and medical cost containment solutions for TPAs, employer groups, school systems, municipalities, hospital systems, Taft-Hartley plans, and fully insured payers as well as for the reinsurance industry and stop loss carriers.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Sally Ann Polson
President & CEO
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