Nurse Case Manager Chronic Disease Management Specialist

Coos Bay, OR - USA

Hourly Salary: $ 35 - 51

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

We are currently hiring aNurse Case Manager - Chronic Disease Management Specialist.If you are an experienced nurse skilled in case management an effective motivational interviewer and value being part of a team that makes a difference you may be the right person for the position!Apply today!

JOB SPECIFICATIONS

Classification:Non-exempt Status: Part-time Monday - Friday generally 8am to 5pm Pacific Time with flexibility for member needs (occasional evenings/weekends)

Salary:$35.29 - $51.38/hourly

Department:Utilization Review Work Location:Hybrid

Reports to:Director of Medical Services Supervision Exercised:Non-supervisory

Job Purpose: Chronic Disease Management Specialist
The Certified Case Manager (CCM) - Chronic Disease Management Specialist provides comprehensive care coordination and management for members with chronic conditions (e.g. congestive heart failure diabetes COPD). This role focuses on improving health outcomes reducing hospitalizations and enhancing quality of life through individualized care plans member education and collaboration with healthcare teams. The CCM utilizes evidence-based practices and certification skills to optimize resource utilization and support health plan with interdisciplinary teams providers and community resources to ensure members receive person-centered culturally responsive and cost-effective care.

Qualifications Education & Experience

Minimum Associate Degree in Nursing required; Bachelors degree preferred
Certified Case Manager (CCM) credential through the Commission for Case Manager Certification (CCMC) strongly preferred
Minimum 35 years experience in case management chronic disease management or a related healthcare role; experience in a managed care or health plan setting preferred
Additional certifications (e.g. Certified Diabetes Educator) a plus

Essential Responsibilities: Certified Case Manager-Chronic Disease Management Specialist

Conduct initial and ongoing assessments of member health status including medical history functional ability psychosocial needs and risk factors
Develop and update individualized care plans based on clinical guidelines (e.g. AHA ADA) and member-centered goals
Coordinate with interdisciplinary teams (e.g. physicians nurses social workers pharmacists) to ensure smooth care transitions and continuity of care
Support care transitions including post-discharge planning and follow-up within 4872 hours
Implement disease-specific interventions such as medication adherence support lifestyle coaching and dietary education
Monitor member progress through routine check-ins (home visits telephonic telehealth etc.) and update care plans based on reassessment
Educate members and caregivers on symptom management self-care and emergency response plans
Review healthcare utilization data to identify cost-effective care opportunities and reduce over-utilization
Advocate for appropriate services in alignment with health plan policies and medical necessity guidelines
Document assessments care plans interventions and outcomes in member records
Provide data and insights to support quality improvement initiatives and performance tracking
Link members to appropriate community and support resources (e.g. transportation palliative care meal programs)
Use technology (e.g. remote monitoring tools) to enhance care management and communication

Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER

Participate in quality and organizational process improvement activities when requested
Support and contribute to effective safety quality and risk management efforts by adhering to established policies and procedures maintaining a safe environment promoting accident prevention and identifying and reporting potential liabilities
Openly clearly and respectfully share and receive information opinions concerns and feedback in a supportive manner
Work collaboratively by mentoring new and existing co-workers building bridges and creating rapport with team members across the organization
Provide excellent customer service to all internal and external customers which includes team members members students visitors and vendors by consistently exceeding the customers expectations
Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
Advance personal knowledge base by pursuing continuing education to enhance professional competence
Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
Represent organization at meetings and conferences as applicable

Knowledge Skills & Abilities

Knowledge of evidence-based practices and requirements to evaluate existing standards and implement new procedures
Understanding of principles of health care of populations
Knowledge of OHP program requirements benefit package eligibility categories and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
Knowledge of the Oregon Health Authorities Coordinated Care Organization required metrics
Understanding of basic concepts of managed care
Critical attention to detail for accuracy and timeliness
High degree of initiative judgment discretion and decision-making
Patient-centered and culturally responsive approach
Ability to exercise sound clinical judgment independent analysis critical thinking skills and knowledge of health conditions to determine best outcomes for members
Proficient in electronic health record (EHR) systems and case management software (e.g. Optum tools)
Knowledge of chronic disease management guidelines and reimbursement models (e.g. Medicare Medicaid)
Strong interpersonal and communication skills for effective member advocacy and interdisciplinary collaboration
Commitment to quality improvement equity and population health outcomes
Ability to report to work as scheduled and willingness to work a flexible schedule when needed
Proficient in Microsoft Office Suite and Windows Operating System (OS)
Training in or awareness of Health Literacy Poverty Informed Systemic Oppression language access and the use of healthcare interpreters uses of data to drive health equity Cultural Awareness Trauma-Informed Care Adverse Childhood Experiences (ACEs) Culturally and Linguistically Appropriate Service (CLAS) Standards and universal access
Knowledge and understanding of how the positions responsibilities contribute to the department and company goals and mission
Knowledge of federal and state laws including OSHA HIPAA Waste Fraud and Abuse
Awareness and understanding of equity diversity inclusion and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social political and environmental contexts of policies programs and practices
Ability to manage multiple priorities and caseloads effectively
Excellent people skills and friendly demeanor
Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems
Attention to detail and organization skills
Ability to handle stress and sensitive situations effectively while projecting a professional attitude
Ability to communicate professionally both conversing and written
Ability to work with diverse populations and interact with people of differing personalities and backgrounds
Sensitive to economic considerations human needs and aware of how ones actions may affect others
Ability to organize and work in a sensitive manner with people from other cultures
Poised; maintains composure and sense of purpose

Working Conditions:

This position must have the ability to remain in a stationary position occasionally move about inside the office to access office machinery printer etc. frequently communicate and exchange accurate information.

Work Condition: hybrid work

Employee generally works within the interior of an office or remote work from home environment.

Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion.

Hours of operations and specific staff scheduling may vary based on operational need.

The office environment is clean with a comfortable temperature and moderate noise level.

Exposed to:

Onsite: Cold/heat controls close contact with employees and the public in office environment. Remote: Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.

Machines equipment tools and supplies used:Constantly operates a computer or other office productivity machinery such as postage machine fax copier calculator multi-line telephone system scanner.

May answer a high volume of telephone calls complete documentation and use computer programs to either obtain or record information.

Multiple Duties:Must be able to work under conditions of frequent interruption and be able to stay on task.

Other Information:

This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of DOCS Management Services employees. Other duties responsibilities and activities may change or be assigned at any time with or without notice.

Required Experience:

Manager