Shareholders and Investors

Position Summary:  
Provides on-site outreach, disease and/or case management, education and support to plan members to support healthy lifestyle choices & to reduce long term effects of chronic illnesses.  Performs other clinically based activities to coordinates care between the members, providers and community based health organizations.

Essential Functions:
1.         Provides telephonic and/or on-site outreach, disease management and/or case management, education and other clinically based activities to plan members. 
2.         Conducts assessments, develops treatment plans and interventions and sets goals for treatment plans/behavioral modification within the scope of practice.
3.         Collaborates with member’s medical/health and community based providers (including the PCP, HCH, certified dieticians, behavioral health specialists, or others as needed) regarding the member’s treatment needs and plan of care. 
4.         Collects clinical data and enters information into database for tracking and metrics purposes. 
Monitors and evaluates the services and community based resources necessary to respond to the individual member’s health needs.

Other Duties:
Completes other special assignments and projects as assigned.

Education:
Requires Licensed RN or Licensed RN with Certifications.  Education required is an Associate Degree in nursing,  Diploma in nursing or Bachelor of Science in nursing; or Psychologist with Masters Degree.

Experience: 
·         Minimum 3 years clinical experience required.
·         Previous experience in a care management, quality improvement, medical record reviews, disease management and/or case management preferred.
·         Professional certification (CCM, CCP) preferred.

Knowledge:
·         Knowledge of Medicare/Medicaid.
·         Knowledge of job specific medical specialty (disease management/chronic illnesses/maternity care).
·         Knowledge of adult learning and behavior change principles preferred.
·         Knowledge of community based resources.

Skills:
·         Clinical assessment skills, consistent with state licensure scope of practice requirements.
·         Excellent written & verbal communication skills.
·         Telephonic interviewing skills.
·         Proficient in Microsoft Office, Internet/Web Navigation.
·         Prioritization and organizational skills.

Reasoning Ability:
·         Ability to assess patient health status, consistent with state licensure scope of practice requirements.
·         Ability to integrate data and evaluate to design meaningful interventions.
·         Must be able to prioritize and target interventions, consistent with state licensure scope of practice requirements designed to support long term behavioral change.