Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
Provides case/care management services to a specific clientele. Screens cases for possible case management services according to predetermined criteria. Systematically identifies and addresses fragmentation of care, and fill gaps in care using proactive initiatives.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Case Managers Only:
- Contacts members of the medical team to discuss the patient's course of progress and needs.
- Arranges for all services required and coordinates services with the health care team to eliminate duplication of services and conserve health benefit dollars.
- Contacts or visits family to ascertain their understanding of the patient's diagnosis and prognosis and the ability to provide caregiver support.
- Identifies problems, anticipates complications and acts to avoid them, provides health instruction to the patient and family and refers the patient back to the physician or other health care team members when appropriate.
- Makes personal visits or contacts the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc.
- Provides authorizations for any modalities of treatment recommended; investigates and suggests alternative treatments when appropriate.
- Documents case summary based on information received and communicates with the beneficiaries and involved providers.
- Conducts personal visits to the patient's home or to the hospital when appropriate.
- Facilitates transfers of beneficiaries throughout the different regions, and within the region, by collaborating with the military liaison to transition the beneficiary with minimal disruption of their health care services.
- Coordinates the basic benefits and identifies and submits benefit modifications as appropriate or submits a request to TMA for benefit exceptions or special programs.
Care Managers Only:
- Contacts patient to assess the patient's condition, understand his/her injury and their ability to follow the treatment plan.
- Educates physicians and appropriate MTF personnel regarding benefits and limitations, as well as payment processes.
- Collaborates with physicians, beneficiaries/families, and involved providers to evaluate beneficiary needs and ensure beneficiaries are receiving adequate services to meet their needs.
- Educates beneficiaries to help them understand their benefits and assists them with maximizing their available benefits.
- Conducts training for other HNFS associates regarding the overall Case Management Program and specific processes such as the case management referral process.
- Contacts patients with upcoming medical or surgical admissions and discusses what they may expect before, during and after the admission.
- Assesses patients' conditions, understanding of their illnesses/ injuries and their abilities to follow the treatment plans.
- Advises patients of the probable length of stay and helps them think through and arrange for services that they might need when discharged from the hospital.
- Contacts patients within 48 hours of discharge and assures proper support and services are in place to make a full recovery (i.e., equipment, home health, other services, transportation, etc.).
Graduate of Nursing program; BSN degree preferred.
- Valid Nurse License, Clinical Psychologist, or Licensed Clinical Social Worker.
- Valid State Drivers License and Certified in Case Management (CCM) recommended.
Knowledge, Skills & Abilities:
- Two years clinical experience in a health care environment.
- Managed care experience desirable.
As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
- Good written and oral communication skills.
- Demonstrated abilities in assessing, evaluating and interpreting medical information.
- Computer operation skills, including proficiency in Microsoft Word, Excel and Access.
- Excellent Interpersonal skills with the ability to work effectively and independently.
- Should have a high level of understanding of community resources, treatment options, home health availability, funding options and special programs.
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%; and 'moderate' refers to 20-40% of the time.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication.
- Required to have speaking ability to express or exchange ideas.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
- Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
- Constant computer usage including typing and/or eye strain.
- Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Significant phone usage; headsets may be required.
- Constant amount of time spent working in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 17 months ago