Health Plan Care Manager

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🦞 Maine – Remote

🦞 Maine – Remote

💵 $86.9k - $107.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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

• Complete comprehensive advanced-level nursing assessments for new and existing members, including focused physical examinations for complex care and comorbidities • Provide care management and care coordination according to CMSA standards and definitions, and apply evidence-based criteria such as CMS and HEDIS quality measures • Manage care within benefits structures and comply with contractual, regulatory, and accreditation requirements including DOD, CMS, URAC, and NCQA • Ensure timely and accurate member assessments, screenings, care transitions, encounters, follow-up, and medical-record documentation • Collaborate with primary care providers, specialists, medical directors, and community service agencies to address member-centered needs • Engage, assess, educate, and support members, families, and caregivers regarding medical, health, social, psychological, environmental, and lifestyle issues • Document assessments, encounters, and other care-management activities in the case-management medical record • Ensure written communications, member records, and forms are complete, clear, organized, professional, and compliant with standards • Develop and present case studies; participate in clinical rounds, in-services, staff education, and training • Demonstrate respectful, professional, and ethical customer service • Assist with process improvements and support quality initiatives • Provide project support and complete additional assignments as required

🎯 Requirements

• Bachelor’s degree in nursing required • MSN preferred • 5 years of current clinical experience required, ideally in medical-surgical, home care, hospice, community health, rehabilitation, long-term care, cardiovascular, diabetes, renal, pulmonary, oncology, or geriatric practice • Experience in a managed care, home health, or hospital environment • Unrestricted state-licensed registered nurse license required • Knowledge of the scope of nursing practice in states where licensed • Current clinical knowledge of chronic diseases, heart disease, COPD, diabetes, renal disease, and other comorbidities • Ability to use sound judgment to identify subtle changes and prevent problems and complications • 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

🏖️ Benefits

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