About this position

Care Manager: As an integral member of the health care team, the care manager provides clinically-based care coordination to support the delivery of quality customer care as efficiently as possible. The care manager has accountability for individual customers ensuring quality clinical outcomes and appropriate resource management within an assigned caseload. With the customer, family, and health care team, the care manager creates and organizes a care plan (or contributes to an existing care plan) appropriate to the customer's needs and resources and ensures that the customer is receiving the right care, at the right level across the continuum.

What we’ll expect from you

• Promotes customer-centered care based on jointly determined health care goals and priorities.
• Ability to reach out to customers to ensure program understanding and enroll in appropriate customer programs supported by their clinic or payer.
• Functions as a resource to customer care units, ambulatory clinics and medical staff regarding the payer products and panel the customer is aligned with.
• Applies clinical judgment to determine level of care and resources needed.
• Monitors, trends and records customer response to disease, illness, treatment.
• Documents appropriately as required by public and payer systems.
• Projects a positive image through professional behavior and building positive relationships with customers, families, providers, and other staff.
• Accepts other duties as assigned to promote the accomplishment of organizational goals.
• The team member is accountable to demonstrate proficiency for the skills outlined in the appropriate position skills list.
• The team member is accountable to maintain skill proficiency, including improvement where deemed necessary, and upgrading any additional or new skills on the appropriate position skills list.



Lead Care Manager – Additional Accountabilities:
• Provides leadership over the general operations of the care management team and will assist in program performance and improvement.
• Serves as the central point of contact for communication between the team and outside stakeholders.
• Works with the Manager and the Program Assistant to ensure the program meets all payor requirements.
• Participates in preparation for annual audits and other compliance activities.
• Works with program leadership to implement new processes and requirements.
• Assists the care management team in problem solving and responding to member or provider inquiries. • Recognizes and complies with legal, regulatory, accrediting and procedural requirements related to area of responsibility.
• Understands and follows principles and standards as outlined in North Memorial's Corporate Code of Conduct.
• Protects customer and team member privacy and only accesses customer and/or team member related information as needed to perform job duties.
• Reports violations or areas of concern to supervisor or Corporate Compliance Officer via established methods of communication.

• Understands and follows principles and standards as outlined in North Memorial's Corporate Code of Conduct.
• Protects customer and team member privacy and only accesses customer and/or team member related information as needed to perform job duties.
• Reports violations or areas of concern to supervisor or Corporate Compliance Officer via established methods of communication.
• Recognizes and complies with legal, regulatory, accrediting and procedural requirements related to area of responsibility.
• Understands and follows principles and standards as outlined in North Memorial's Corporate Code of Conduct.
• Protects customer and team member privacy and only accesses customer and/or team member related information as needed to perform job duties.
• Reports violations or areas of concern to supervisor or Corporate Compliance Officer via established methods of communication.

Interested? Here are our requirements

Education

• Graduate from an accredited school of nursing required; BSN or BAN preferred; or BSW from an accredited school of social work.   

Experience, Knowledge, Skills, Abilities 

• RN Required. Experience with transgender or gender care clinic preferred. Care coordination experience preferred. Previous MSHO Experience preferred.
• Clinic experience preferred. • Excellent verbal and written communication skills required.
• Needs assessment skills.
• Evaluation skills.
• Knowledge of relevant policies and procedures.
• Customer interaction and motivational skills.
• Customer triage skills.
• Project a positive image through professional behavior and building positive relationships with customers, families, providers and other staff.
• Demonstrated ability to collaborate with other disciplines both in and out of health care system.
• Demonstrated ability to problem solve proactively using sound judgment based on factual information and clinical knowledge.
• Demonstrated ability to use behavioral strategies such as motivational interviewing.
• Demonstrated understanding of concepts associated with utilization management.      

Licensure/Certification(s) Mandatory

• Registered Nurse OR
- State Requirement
• Licensed Social Worker
- State Requirement