Condition Health Case Manager - Schenectady or Rochester
MVP Health Care 32 reviews - Rochester, NY

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Under the direction of the Case Management Manager; The Case Manager will serve as the primary vehicle for assisting the members with the coordination and management of their health care needs. The Case Manager will telephonically assess, identify needs, coordinate, educate, case manage and/or coach members. Their purpose will be to provide direct assistance to members and their treating physicians to facilitate the management of the member s health care, as well as, provide and/or coordinate a wide array of health care related support and educational services. The Case Manager will act as a proactive partner with the member and will be available to help them navigate through the health care delivery system, understand their benefit coverage and coordinate with other relevant providers involved in their treatment. Will document a plan of care and prioritizes goals that are developed in conjunction with the member, caregiver and their providers. The goal is to help members regain optimum health or improved functional capability, in the right setting, focusing on achieving patient centered, quality, safe, cost-effective outcomes. This involves comprehensive assessment of the member s condition; determination of available benefits and resources; and development and implementation of a case management plan with performance goals, monitoring and follow-up. Monitor and review cases with medical director to assure appropriate outcomes. Other duties as assigned by supervisor. POSITION QUALIFICATIONS: Minimum Education/Experience: Bachelor's degree in Nursing, New York State RN Licensure required and 3 years clinical experience or Associates Degree in Nursing, New York State RN licensure required with 7 years of recent clinical experience. Certification in Case management (by CCMC) and/or Health/Wellness certification required within 24 months after hire. Required Skills: Ability to communicate independently and directly with members, providers and staff with calmness, assertiveness, diplomacy and in a non-confrontational manner. Excellent oral and written communication skills, including ability to compose correspondence. Excellent computer skills including strong working knowledge of Word, Windows based applications and the internet. Demonstrated clinical experience in and knowledge of population health management, case management and disease management. Detail oriented with strong organizational skills. A team player able to work well in an energetic, dynamic and deadline oriented environment. Previous experience required in situations demanding strict adherence to confidentiality. Must be able to solve problems while exhibiting clinical judgment and realistic understanding of the current environment. Must be able to make independent decisions about appropriateness, resource utilization, and quality of care without supervisory assistance except in unusual circumstances. Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations


About this company
32 reviews
MVP Health Plan covers about 650,000 most valuable people. Also known as MVP Health Care, the company provides health insurance and employee...