RN Case Manager/Care Coach

Profile

Description

Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.

Responsibilities

The Case Manager/Care Coach will work in clinic alongside providers and staff to assess discharge care coordination needs of patients, make telephonic follow up calls and coordinate services for identified members who have acute and long-term chronic conditions and or needs.

The RN will also work with members that have been discharged from acute facilities to facilitate care post discharge. The RN will be an integral part of daily clinical rounds and interact with all levels of nursing and other departments to assure effective utilization of resources that meet the physiological and safety needs of the patient and their families. The RN will also assess for continuation of Long term needs and monitoring through the enrollment into the Conviva Case/Disease management program. The RN will simultaneously work with the members in the programs and follow the patients for continuity of care.

Job Functions:

The Case Manager/Care Coach will work the following:


Able to utilize skills in an environment which has fluctuating and unpredictable work volumes

Able to use nursing experience and judgment to anticipate members' care coordination needs

Refer complex patient concerns to the member's physician and medical director for appropriate interventions

Works closely with the hospital case managers, attendings, PCP and medical director, community agencies and other approved vendors to ensure the member's healthcare needs are met

Acts as resource, able to facilitate eligibility and benefit information

Acts as a resource and is familiar with the provider network

Maintains accurate, concise documentation, adheres to documentation NCQA guidelines

Adheres to the Conviva Care Solutions policies and procedures

Adheres to the attendance policies and procedures

Maintains confidentiality and adheres to HIPPA guidelines at all times

Maintains professionalism at all times

Attends meetings and in-services as assigned

Identifies barriers and problems and reports appropriately to ensure member satisfaction

Assists with other assignment coverage as needed, and prioritize workload

Demonstrates flexibility in work performance to meet department, company and individual goals

Assists in monitoring logs and maintaining statistics

Consistently meets work schedules, productivity requirements and deadlines

Maintains licensure and certifications

Able to effectively use computer and other office equipment

Assists other employees as necessary

Enroll patients in the delegation case/disease management after transition of post hospital discharge for continuation of care and conditions

All documentation must meet the CCM requirements for audits quarterly and annually

Has a dotted line reporting structure to Director of Disease/Case management


Qualifications/Requirements:


Bachelor's Degree required Minimum two years' experience

Excellent customer service. Must interact with patients in a respectful and amicable manner.

Employees are expected to treat patients with compassion and protect their rights.

Adhere to all Company policies.

Documentation Skills

Analyzing Information

Decision Making

Research Skills

Verbal Communication

Written Communication

People Skills

Resolving Conflict

People Management

Excellent written and verbal communication skills. Demonstrate active listening skills; communicates clearly and concisely; ensure understanding regardless of the communication vehicle; understand the needs and perspectives of others with ability to tailor the delivery accordingly; share information appropriately.

Demonstrated ability to create an exceptional patient experience leveraging excellent customer service skills.

Interpersonal effectiveness (emotional intelligence): Understand oneself, effectively manage emotions, listen and communicate with respect, and build trusting relationships

Ability to work well with a team; Develop and manage interpersonal relationships with entire care team

Responsible for achieving organizational goals and accountable for results. Meet established expectations and take accountability for results; encourage others to do the same.

Strong organization and time management skills with the ability to prioritize and multi-task.

Self-motivated and committed to achieving best results

Possess critical thinking skills, independent decision-making capability

Implement physician approved care plans for patients in the Care Coordination System.

Lead and collaborate with other members of the healthcare team in the planning, directing and evaluating patients in the Care Coordination System

Monitor and care for high risk patients with acute and chronic medical conditions

Assess patient needs; develop, plan, implement and evaluate goals with interventions for the care plan to meet patient's and family's needs

Educate and teach patients and families face to face and telephonically regarding patient disease and procedures that will directly affect the patient.

Flexible to changes in work schedule and location as needed by the organization

Other duties as assigned

Computer literate with strong understanding and ability to use Word, Outlook, PowerPoint and Excel with demonstrated proficiency, familiar with laptops, printers

Attends and participates in meetings


Being a part of the Conviva team gives you: We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k, tuition reimbursement, vacation, paid holidays, work-life balance, growth, a positive and fun culture and much more.

Scheduled Weekly Hours

40

Company info

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