At Affinity Health Group, we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k).
Affinity is currently looking for a Clinical Care Manager RN to work from 8:00AM – 5:00PM, Monday through Friday.
Assess our Medicare, Commercial and Exchange members needs and requirements in order to achieve and/or maintain optimal wellness state. The Clinical Care Manager Registered Nurse will receive and evaluate referrals for care management and resource needs. They will also guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Clinical Care Manager Registered Nurse will work in collaboration with the member. Work in collaboration with the member, the members care providers and a multi-disciplinary team, employing a variety of strategies, approaches and techniques to identify and assist members with health maintenance issues which might affect overall patient health and positive health outcomes.
Essential Duties & Responsibilities:
• Proactive telephonic outreach to eligible Affinity Health Plan members patients and/or AHG clinic patients to and engage participation in CMS Comprehensive Primary Care Plus (CPC+) Care Management Program.
• Actively participate in all enrollment activities.
• Receive and evaluate referrals for enrollment into CPC+ Care Management and other resource needs such as Social Services, Behavioral Health or community resources.
• Complete assessment for the purpose of providing appropriate, timely interventions to ensure provision of optimal care.
• Coordinate community care and services as deemed appropriate.
• Works collaboratively with other members of the VantageCare Interdisciplinary team including but not limited to: Vantage Case Managers, Field Care Managers, Social Services, Behavioral Health, Disease Management, Transitional Care, and providers including the members’ Physician(s) and other healthcare providers. Coordination of care with Home Health Providers.
• Understands clinical program design, implementation and management, monitoring and reporting.
• Complies with performance and reporting standards as defined by CMS.
• Participates in quality improvement processes
• Participates in Interdisciplinary Care Team meetings as needed
• Serves as a liaison and patient advocate when deemed applicable or as requested by the patient or patient’s legally appointed representative.
• Additional responsibilities as deemed appropriate by CPC+ Coordination leadership.
M arginal Duties:
• Assists as needed with other duties in the role and is flexible to new ideas.
• Actively serves on the Care Management Team and attends Care Management Team meetings.
• Participates as needed on the QI Committee
• Able to work in several computer program systems, (Word, Outlook, Excel, Faxcom) and documents in the electronic medical record.
• Able to work independently and interdepartmentally to obtain departmental and organizational goals.
• Other duties as assigned.
• Accountability – meets established expectations and takes responsibility for achieving results; encourages others to do the same. Employs focus, attention to detail, reliability, and appropriate prioritization to drive outcomes. Sees opportunities to contribute and takes the initiative to create solutions.
• Builds trust – consistently models and inspires high levels of integrity in decisions, speech, and actions. Lives up to commitments, taking responsibility for the impact of one’s actions. Prioritizes principles and values over personal or professional gain.
• Customer Focus – connects meaningfully with customers to build emotional engagement and customer advocacy. Develops and applies deep customer knowledge and intimacy to develop and deliver products, services, and interactions that provide value beyond expectations.
• Executes for results – effectively leverages resources to create exceptional outcomes. Determines the best course of action when facing ambiguity. Anticipates and constructively resolves barriers and constraints. Embraces change, applies new knowledge and reconfigures quickly to capitalize on opportunities.
• Understands or becomes knowledgeable of quality monitoring and improvement activities
Knowledge, Skills, and Abilities:
• Graduate of an accredited school of Nursing with current license to practice as an RN in Louisiana.
• Three plus years of general clinical experience required
• Previous Case/Care Management or Utilization Review experience
• Case Management Certification is a plus, but not required
• Exceptional interpersonal, verbal, and written communication skills
• Concise, clear documentation skills
• Strong problem-solving skills
• Ability to travel to other clinics and or educational trainings
• Ability to work with limited supervision and to make decisions based on established policies and procedures
• Works under the direct supervision of the CPC+ Clinical Care Management Coordinator.
• Overtime will be occasionally required.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel, reach with hands and arms, and talk or hear. The employee is frequently required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and frequently lift and/or move up to 25 pounds.
Complex Problem Solving