Job description
Summary of Position
- Support EmblemHealth population health complex care management initiatives by providing care management services
- Provide oversight to a multidisciplinary care team responsible for a population of health plan enrollees in a discrete “case
- Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate
- Serve as the “quarterback” or “leader” of a care pod (care team) who will assess and triage members to the most appropriate
Principal Accountabilities
- Assess and evaluate needs of our most complex members, coordinating care utilizing the most appropriate resources
- Engage actively with the member PCP /designee
- Engage with the member in support of their treatment team to identify and establish attainable goals that positively
- Act as the “triage” lead for the care team to identify members with changing conditions in the case panel supporting
- Assess the needs of members in the case panel and align them with the appropriate member of the care team
- Monitor care team performance to ensure that members of the case panel are engaged in a timely fashion and that
- Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care
- Serve as an informal leader of the team with the goal of maintaining team performance and high morale.
Education, Training, Licenses, Certifications
- Bachelor’s degree from an accredited college or university.
- Active, unrestricted RN license.
- CCM certification required. Consideration given to certification candidates, but certification must be completed within 12
Relevant Work Experience, Knowledge, Skills, and Abilities
- 5 – 8+ years of clinical experience. (R)
- Staff and process management experience; ability to manage staff performance. (R)
- Advanced knowledge of complex medical conditions to properly address/escalate issues. (R)
- Ability to identify, implement, and ensure compliance with established metrics and procedures. (R)
- Prior health plan experience. (P)
- For Albany location(s): must be physically present at specific site locations at least 3 – 4+ times/month. (R)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences; and the ability
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.). (R)
- Ability to build relationships both internally and externally while delivering excellent customer service. (R)
- Experience in compiling and analyzing data. (R)
- Experience with data retrieval and statistics. (P)
- Must be detail-oriented with strong organizational skills, including the ability to coordinate workflow. (R)
- Knowledge of / familiarity with community resources and social service resources to assist patients with social needs. (P)
- Demonstrated knowledge with the regulatory requirements of DOH, CMS, NCQA. (R)
Additional Information
- Requisition ID: 1000000826_02
- Hiring Range: $72,000-$138,000
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