ResponsibilitiesCoordinate and manage care for Southcoast Employee Health Plan members across the continuum of care, primarily through telephonic engagement. Develop and implement individualized, patient-centered care plans, establish measurable goals, and monitor outcomes to support optimal health and well-being. Drive member participation in care management programs for individuals with complex medical needs and chronic conditions. Collaborate with the Southcoast Employee Health Plan, third party vendors, providers, and interdisciplinary care teams to improve health outcomes, enhance the member experience, and ensure continuity of care. Conduct utilization management and monitor healthcare services to support quality, cost-effective care and achievement of clinical and operational outcomes. Maintain timely communication with the Benefits team regarding program participation, engagement trends, care management activities, and issues requiring escalation, while ensuring strict protection of confidential health information and compliance with HIPAA and privacy standards. Support other clinical programs within the Population Health division portfolio.
Qualifications- Current Massachusetts or Rhode Island LPN licensure is required.
- Candidates must have a minimum of three years of relevant experience. Prior experience as a Care Manager, Case Manager, or Care Coordinator in home care, inpatient, physician practice, or case management settings is strongly preferred.
- Experience using Electronic Health Records (EHRs) is required. Demonstrated ability to manage sensitive and confidential employee health information with a high degree of professionalism, discretion, and integrity.
- Experience working in a healthcare benefits, employee health, care management, or health plan environment is preferred.
- Proficiency in computer applications, including accurate typing skills and the effective use of technology, is essential.
- Strong customer service, communication, interpersonal, critical thinking, and problem-solving skills are required.
- Current license in Massachusetts and Rhode Island as an LPN is required.
- Must be fully vaccinated against seasonal Influenza and the COVID 19 virus or to be exempt from the requirement for medical or personal reasons by signing a statement certifying you are choosing to be exempt from vaccination once hired.
- Compensation: Pay rate will be determined based on level of experience.
Pay RangeUSD $31.89 - USD $47.56 /Hr.
