Health Plan Care Manager

🔥 2 minutes ago

🦞 Maine – Remote

🦞 Maine – Remote

💵 $86.9k - $107.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🛡️ Insurance

📦 Logistics

💼 Consulting

Insurance • Logistics • Consulting

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• Provide comprehensive, person-centered care management interventions for enrolled members and families • Engage, assess, monitor, educate, coordinate, and provide interventions to improve care quality and health outcomes • Reduce unnecessary health care utilization and hospital utilization • Complete comprehensive advanced-level nursing assessments, including focused physical examinations • Apply evidence-based standards, criteria, and HEDIS quality measures • Manage care within benefits structures and compliance, contractual, and accreditation regulations • Complete timely member assessments, screenings, care transition assessments, encounters, and follow-up • Document assessments, encounters, and activities in the case management medical record • Collaborate with primary care providers, specialists, medical directors, hospitals, skilled nursing facilities, home health providers, community agencies, members, families, and caregivers • Address medical, health, social, psychological, environmental, and lifestyle issues • Develop and present case studies; participate in clinical rounds, in-services, staff education, and training • Demonstrate respectful, professional, ethical conduct and excellent customer service • Assist with process improvements and quality initiatives • Provide project support and complete additional assignments as required

🎯 Requirements

• Bachelor’s degree in nursing required • 5 years of current clinical experience • Experience in medical-surgical, home care, hospice, community health, rehabilitation, long term care, cardiovascular, diabetes, renal, pulmonary diseases, oncology, or geriatrics • Experience in a managed care, home health, or hospital environment • Unrestricted state licensed registered nurse license required • Knowledge of Scope of Nursing Practice in states where licensed • Current clinical knowledge in chronic diseases, heart disease, COPD, diabetes, renal disease, and other co-morbidities • Must be a self-initiator with high energy/productivity and a strong work ethic • Proven history as a team player • Flexibility and adaptability in managing multiple priorities and changing schedules • Excellent written and verbal communication skills • Excellent organizational and time management skills • Must verify U.S. citizenship • Must complete employment eligibility verification upon hire • This position is not eligible for immigration sponsorship

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Retirement savings with employer contributions • Paid time off • Volunteer time off • Pie day • Other employee benefits