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J210718

Care Mgr Disease Mgmt

Highmark Inc.

  • Company Highmark
  • Home, NY
  • Clinical Services
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
ADA
E1. Acting as an advocate and liaison to meet a member’s individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services. This is accomplished by using communication and available resources to promote quality, cost-effective outcomes in accordance with available contract benefits.
E2. Exhibits and applies clinical understanding of the medical diagnosis (es), case management processes, and psycho-social needs of members and their support system toward the development of an appropriate treatment plan in conjunction with the member’s physician(s) and other pertinent allied health professionals.
E3. Works collaboratively and communicates clearly and professionally with physicians, providers, co-workers and other members of the health care team in order to carry out the established plan of care.
E4. Demonstrates a thorough understanding of and applies the principles/standards of URAC and NCQA, Medical Services initiatives, and Strategic Business Unit goals.
E5. Identifies areas for potential cost savings, quality improvement and workflow efficiencies.
E6. Ability to work both as a team member and independently, demonstrating sound problem solving techniques.
N7. Performs other related duties as requested.

Education/Experience/Skills Requirements


Required Education:
Associates Degree: Nursing

Required Experience:
Nursing NY State licensed RN; Multi-state RN licensure preferred.

3-5 years clinical experience.

Bachelor’s Degree preferred with a 3 years clinical experience, 2 of which must be in a hospital setting.

Multi-state licensure preferred.

Required Knowledge/Skills:
1. Knowledge of disease management, triage, managed care, health insurance industry, and the provider community a plus.
2. Excellent time management skills
3. Excellent verbal and written communication skills
4. Ability to work effectively with minor supervision
5. Must be able to work in a fast-paced environment with daily work processing deadlines
6. Persuasive communication style
7. Polished, professional image and reputation
8. Demonstrated customer service orientation
9. Demonstrated personal accountability
10. Knowledge of MS Word, Excel, Access, and Internet preferred

Required Licenses/Certifications:
Registered Nurse
Registered Nurse OR Licensed Clinical Social Worker (LCSW) ORLicensed Mental Health Counselor (LMHC)
Problem Solving
Managerial/Supervisory Responsibilities
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Financial/Budgetary Responsibilities:
Other Job Specifications:
External Contacts:
Working Conditions/Physical Demands:
Position requires:
* Must be able to work in an office environment
Position involves:
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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