Case Manager

At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Responsibilities:

• Identifies potential candidates for individual case management services and executes the screening and case management process.
• Implements, coordinates and monitors efficient care for targeted patients using a variety of healthcare delivery systems as appropriate. The delivery systems can include acute, long-term care, subacute, skilled nursing and rehabilitation settings, as well as, surgery centers, home health agencies and other settings.
• Works closely with patients at the time of enrollment to identify those who are currently high cost/high utilizers or at-risk for high cost/utilization.
• Assesses the new patient's situation, provides information about healthcare options, serves as a guide and advisor to the patient and his/her family, and establishes a long-term relationship with the primary care physician and patient.
• Works with the primary care physician to establish protocols for routine and preventive care for the patients, which reflect accepted standards of care.
• Researches and selects care options as appropriate. May make recommendations of alternative medical care and alternative non-medical services for approval and authorization by the primary care physician.
• Supports utilization management decisions with nationally recognized medical management criteria.
• Performs discharge planning coordination.
• Refers all cases that do not meet applicable criteria or have potential quality of care issues to the Physician Advisor.
• Maintains a comprehensive, computerized medical and social history for assigned patients. Information will be used for such activities as patient assessment, care planning, patient/care evaluation, case tracking, and risk predictions, as well as, cost analysis.
• Works to facilitate patient compliance and ensure continuity of care per the team's "care plan" through the patient's tenure in the program.
• Regularly assesses and evaluates the effectiveness and quality of health care services and treatments provided to patients by analyzing outcomes and reports.
• Provides individual client focused reports accentuating Case Management activity and outcome.
• Establishes a network of community resources necessary for providing appropriate care to patients.
• Serves as a program advocate by conducting training sessions, offering presentations, visiting providers, etc.
• Negotiates rates with vendors according to company policies and procedures. Facilitates the flow of claims through the Healthcare Management Department. Maintains a focus on timely customer service for internal and external customers.
• Provides input to the evaluation of the program's overall effectiveness.
• Makes recommendations for system development from a user's perspective.
• Assists with the orientation of new Healthcare Management personnel, offers assistance to co-workers and contributes to the ongoing networking of expertise with co-workers.
• Assists in special projects.
• Participates in Quality Management initiatives.
• Maintains active nursing license and continuing education requirements.
• Other duties as assigned.

Required Job Qualifications:

• Associate's Degree in Nursing required.
• Active RN License required
• Minimum three years of clinical care required.
• The ability to obtain CCM certification within 18 months of hire date, if not currently active
• Demonstrated problem solving skills
• Possess strong time management and organizational skills
• Ability to work independently and complete tasks in a timely manner, reprioritizing workload to meet customer needs
• Excellent customer service skills
• Ability to work in a fast-paced, customer service driven environment
• Proficient in MS Word, Excel and Outlook
• Ability to accurately document system notes while engaging callers
• Ability to provide excellent communication in verbal and written form
• Ability to read and interpret documents, criteria, instructions, and policy and procedure manuals
• Excellent interpersonal skills
• Ability to effectively communicate with employees, employers, physicians, families in crisis, community agencies and all levels of leadership
• Ability to use commonsense understanding to carry out instructions furnished in written, oral or diagram form
• Ability to use critical thinking skills to deal with problems in varying situations and reach reasonable solutions

Preferred Job Qualifications:

• Bachelor of Science in Nursing preferred
• Case Management or Utilization Management experience preferred
• Experience working with Native America populations in chronic condition management
• Bilingual

Please note: While this role is based remotely, candidates must live in one of the following states to be considered: IL, IN, IA, KS, MO, MT, NM, NC, OK, PA, TX or WI.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement:

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan,pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package forassociates.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

Min to Max Range: