Zillion Technologies is hiring a
Care Manager

Summary

Join Zillion Technologies Inc. as a Remote Care Manager, RN. Assist in providing high-quality, cost-effective health care to members with complex medical and/or psychosocial needs.

Requirements

• Bachelor’s degree in nursing or RN certification and 3 years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations
• 3-5 years of experience in working in Acute Care/Managed Care

Responsibilities

• Communicate effectively while performing customer telephonic interviewing and communication with external contacts
• Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States
• Educate members in order to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes
• Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers
• Collect member medical information from a variety of sources and use appropriate clinical judgment
• Develop an individualized plan of care designed to meet the specific needs of each member
• Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated
• Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services
• Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination
• Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible
• Work within a Team Environment
• Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services
• Participate in departmental and/or organizational work and quality initiative teams
• Case collaborate with peers, Case Management Specialists, Management Team, Physician Advisors, and other interdepartmental contacts
• Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources
• Foster effective work relationships through conflict resolution and constructive feedback skills
• Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable
• Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served in order to foster constructive and collaborative solutions to meet member needs

Preferred Qualifications

• Bilingual English/Spanish language skills
• Case Management Certification