CRE Portfolio Manager III managing commercial portfolio risks and optimizing customer relationships. Working directly with Relationship Managers and overseeing portfolio quality and administration.
About the role
- Field Nurse Case Manager providing assessments, planning, and coordination of healthcare for members. Engaging with members to enhance their overall wellness through tailored action plans and support services.
Responsibilities
- Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness
- Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration
- Services strategies policies and programs are comprised of network management and clinical coverage policies
- Coordinates and implements assigned care plan activities and monitors care plan progress
- Conducts multidisciplinary review in order to achieve optimal outcomes
- Identifies and escalates quality of care issues through established channels
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
- Helps member actively and knowledgeably participate with their provider in healthcare decision-making
- Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Requirements
- License Registered Nurse
- 3+ years clinical practice experience
- 1+ year Case Management experience
- MCO experience preferred
- Star Kids experience preferred
- Bilingual preferred
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
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