Summary

The job involves coordinating care for health plan members under the supervision of medical professionals. The role includes scheduling follow-up appointments, assessing patients' clinical information, providing health services counseling, identifying non-covered services, and complying with HIPAA guidelines. A Bachelor’s degree, Registered Nurse certification, and at least 2 years of Case Management Experience are required.

Requirements

Bachelor’s / College Degree
Registered Nurse
Minimum of 2 years’ experience of Case Management Experience

Responsibilities

Coordinates follow-up care appointments and/or assists in directing care to physician clinic nurse or ITC clinic and/or medical services for post-hospitalized patients
Assesses patients' clinical information and effectiveness of current medical services through phone or in-person interviews at the hospital at the time of discharge
Investigates and solves problems relating to patient responses indicating continued medical problems, plan of care failures, knowledge deficits, and other responses of concern
Provides health services counseling regarding identified patient knowledge deficits, such as dietary information, medication orders explanation, and rationale for immediate follow-up with primary care physician/ITC, etc
Identifies need for non-covered services and provides options for the patient with the assistance of hospital case manager(s) and/or social worker(s)
Identifies urgent issues and forwards them to the case manager, case manager supervisor, case management manager, or PCP as indicated

Preferred Qualifications

Excellent communication, time management and computer skills
Excellent oral & written communication and listening comprehension
Customer Service Skills for interacting the doctors, physicians, and patients
Proficiency with Microsoft Applications
Highly organized with a strong attention to detail
Comfortable in a fast-paced environment
Approachable, professional, discrete, and personable

Benefits

Provides utilization management and quality improvement in accordance with utilization policies and processes

Phoenix Virtual Solutions is hiring a Case Manager