The Care Manager performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs.
Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs of the member.
Case Manager to contact each case managed patient, at a minimum, once a month and coordinate care or on an as needed basis. 20 member contacts required daily. Update caseload, care plans, reporting as required by department policy
Create patient record in HealtheCare system and chart file for each case managed patient with appropriate documentation, authorizations and contact information, including care plan, assessment, progress notes, etc.
Monitors and evaluate effectiveness of the care management plan and modifies as necessary to meet NCQA requirements to include all required elements.
Interfaces with Medical Director as needed and attends weekly case management rounds.
Conducts outbound calls to assign high risk or chronic case managed members.
Aids the member in solving issues such as transportation, social problems, referrals, resources, etc.
Work with member’s family and physician to coordinate care.
Educates member on compliance with physician, health educator, setting short and long term goals.
RN unrestricted active license required in State of PA
At least 2 years’ experience in case management preferably in a medical group or health plan setting.
Strong clinical background must be familiar with developing care plans and assessments.
Ability to maintain a minimum case load of 150 cases.
Able to act independently and make independent decisions.
A solid ability to prioritize and multi-task.
Excellent communication skills.
Able to type a minimum of 40 wpm.
Basic computer skills necessary for inputting clinical data
Maintain courteous professional attitude when working with internal and external customers.
Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements.
Crozer Health, the largest employer in Delaware County, is dedicated to providing a work environment that promotes professional growth and provides enrichment opportunities for its employees. Crozer Health is committed to the improved health status of those we serve.
Working with our community, our goal is to build a healthy place to live and work, and a sound environment in which to build and maintain our families. The health system offers competitive salary and benefit packages, receives consistently high employee satisfaction scores and offers employees a rich array of professional educational opportunities.
Equal Opportunity Employer
Internal Number: 35386
About Crozer Health
Crozer-Keystone Health System, the largest employer in Delaware County, is dedicated to providing a work environment that promotes professional growth and provides enrichment opportunities for its employees.The health system offers competitive salary and benefit packages, receives consistently high employee satisfaction scores and offers employees a rich array of professional educational opportunities.Provider OpportunitiesWith more than 300 dedicated physicians and advanced practitioners, the Crozer-Keystone Health Network provides employment opportunities to primary care and specialty physicians and advanced practitioners throughout Delaware County and the Philadelphia Suburbs.Nursing OpportunitiesCrozer-Keystone has full- and part-time nursing positions available at all four of our acute care hospitals. We are seeking registered nurses (RNs) for our Emergency Departments, Intensive Care Units (ICUs), Neuro ICU, Operating Rooms and Burn Treatment Center.