Coordinator, Medicare Care Management - Full-Time (Network Health) job at Ministry Health Care in Appleton

Ministry Health Care is at the momment seeking for Coordinator, Medicare Care Management - Full-Time (Network Health) on Mon, 08 Jul 2013 21:07:20 GMT. Network Health has three great opportunities for RN's with experience in Case Management. The Medicare Case Management positions are full-time day shift positions scheduled to work Monday - Friday from 8 AM - 5 PM. The Medicare Care Management Coordinator advocates for and supports Medicare member care management needs at all levels of health and across all settings of care with an emphasis on...

Coordinator, Medicare Care Management - Full-Time (Network Health)

Location: Appleton Wisconsin

Description: Ministry Health Care is at the momment seeking for Coordinator, Medicare Care Management - Full-Time (Network Health) right now, this job will be placed in Wisconsin. More details about this job opportunity kindly see the descriptions. Network Health has three great opportunities for RN's with experience in Case Management.
The Medicare Case Manag! ement positions are full-time
day shift positions scheduled to work Monday - Friday from 8 AM - 5 PM.

The Medicare Care Management Coordinator advocates for and supports Medicare member care management needs at all levels of health and across all settings of care with an emphasis on empowering members and their caregivers to achieve improved outcomes and higher quality of life. They also effectively manage care and resources based upon evidence based guidelines and approved measures.

Job Description:
Screens eligible Medicare Advantage candidates for case management program, completes initial assessment, develops care plan with short and long term goals, interventions and timeframes for re-assessment.

Completes on-going case management process for members in open active and/or passive case management per NHIC standards, completes follow-up assessment and evaluates members' progress towards identified short and long term goals. Updat! es plan of care as needed to ensure goals are met, and closes ! cases per criteria (e.g. when expected outcomes/goals are reached)

Participates in facility based member/patient care conferences as appropriate, to ensure quality care, appropriate use of services, and discharge planning.

Provides education and coaching regarding disease/case management activities and processes to members, families, caretakers and providers.

Follows NHIC process in authorizing requests for selected services on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, documenting all care management communication, decision making criteria and actual decisions. Refers all medical necessity denials to Medical Director for determination.

Evaluates and coordinates member referrals from physicians to other specialty providers, specifically tertiary and non-plan providers.

Collaborates with providers, Quality Improvement, Risk Adjustment, Disease Management, Social Serv! ices and Information Systems staff in development, implementation evaluation of population disease management including identification of high risk population, e.g. CHF, COPD, Pneumonia, Frail Elderly, etc.

Supports Care Management Department program development and goals through active participation e.g. community based education, case management program development and evaluation, self-development and training, etc.

Assists in training new staff within department and interdepartmentally as requested.

If assigned to Medicare Advantage dual eligible Special Needs Plan program, provides case management services to those members residing within the community per regulatory requirements and established NHIC policies and procedures.

Performs other duties and responsibilities as assigned.

Qualifications:
Graduation from an accredited school of professional nursing. BSN preferred.
Current Registered Nurse licensure in Wi! sconsin.
Case Management Certification desirable.
Minimum of fo! ur years clinical health care experience as a Registered Nurse.
Prior care management or disease management experience desirable.
Excellent communication and decision-making skills and the ability to work independently and prioritize work.
Knowledge of disease management and behavior change theory.
Skilled in basic personal computer applications.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Ministry Health Care.

If you interested on this job just click on the Apply button, you will be redirected to the official website

This job starts available on: Mon, 08 Jul 2013 21:07:20 GMT

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