Our Case Manager will provide onsite telephonic support to members who are a part of Wellmark’s Condition Support program. You will be responsible for completing assessments to identify risk factors and barriers leading to gaps in health care. In addition, you will create and manage individual care plans that ensure our members receive appropriate care and achieve their health care goals. Collaboration with the member, family, physician, and other members of the multidisciplinary health care team will be critical in your assessment, determination, and resolution of current/future healthcare needs to ensure quality, cost effective outcomes. We'll ask that you demonstrate caring, respect, honesty, and understanding in your interactions with members, providers and community agencies as they work to provide a continuum of care for our members.
**This position works out of our headquarters in downtown Des Moines.
**Ability to work a flexible schedule with shifts between the hours of 8:30 AM-7:00 PM Monday – Friday and 9:00 AM-5:30 PM Saturday is required.
- Accountability: Owning and taking responsibility for one’s actions.
- Business Acumen: Understanding industry, market, financial and company specific operations.
- Collaboration and Communication: Working together; listen to other’s ideas; communicate accurately and concisely.
- Decision Making: Consider all facts and impacts when making decisions.
- Focus on the Customer: Consistently doing what is in the best interest of our customer. Leaving a positive impression on the customer by elevating their experience; making it simpler and educating to helping them understand.
Minimum Qualifications Required (all must be met to be considered):
- Completion of an accredited registered nursing program.
- Active and unrestricted RN license in Iowa or South Dakota (individual must be licensed in the state in which they reside).
- 4 years of related clinical experience – e.g., background in chronic disease in an acute care, home health care, or related setting.
- Demonstrated experience understanding Disease Management regulatory and accreditation standards.
- Strong communication skills, including verbal and written, and the ability to provide education and information to others ondifficult/complex medical issues.
- Proactive approach to problem solving; ability to use deductive reasoning to research, ask questions, seek to understand, and weigh alternative options appropriately.
- Time management/prioritization skills and attention to detail; ability to work in a fast-paced environment while meeting deadlines and accuracy standards.
- Experience with computer software applications - e.g., electronic charting, Microsoft Office, documentation systems.
- Ability to obtain Certified Case Manager (CCM) certification within 24 months after hire and maintain throughout employment.
Hiring Specifications Preferred:
- Bachelor's Degree in Nursing, Public Health, Healthcare Administration, or other related field.
- Related work experience in the areas of disease management or case management, including assessment of members, creating and managing care plans, etc.
a. Telephonically engage with members who are part of Wellmark's support program to discuss and assess health care needs by recognizing signs and symptoms of condition specific risks that warrant different or greater levels of care.
b. Effectively engage member in the participation of the program and educate members on their accountability and expected outcomes including services and benefits appropriate to their current medical status.
c. Determine what types of care or education are necessary for the member and creates and monitors care plans with specifics goals and interventions to close the gaps. Monitor results and trends and make recommendation to leaders and/or advisory team/groups regarding change, as appropriate.
d. Actively research and stay abreast of appropriate resources and/or programs that may help improve the health of the member. Collaborate with and facilitate referrals to providers, community resources and Wellmark programs as necessary.
e. Document care plan and interactions in an accurate, consistent and timely fashion following the standard work guidelines and policies tosupport internal and external report processes. Attain specified quality assurance and review metrics.
f. Provide education to the member on services and benefits appropriate to their current health status and needs regarding their support care. Reduce barriers in the health care delivery system to ensure the member has access to and uses appropriate, quality, health care services by matching the services to the members needs, avoiding duplication of effort and improving provider-member communication.
g. Collaborate with and facilitate referrals to providers, community resources/programs and Wellmark programs to improve the health of the member. Comply with regulatory standards, accreditation standards and internal guidelines remain current and consistent with the standards pertinent to the Case Management team.
h. Other duties as assigned.Apply for this job onlineRefer this job to a friendShare on your newsfeed