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Coventry  Health Care  is currently seeking an Advanced Illness Complex Case Manager  for our Kansas City, MO location.   The Condition Management Program case management model focuses on chronically ill members. The ideal candidate will have experience with working in palliative & hospice care;; a clinical familiarity with a culturally diverse and aged patient population is preferred. This position will provide a holistic approach to case management, including addressing physical, emotional, spiritual & psycho-social needs of members and their families.  The Advanced Illness Case Manager will help members and care givers manage  daily symptoms,develop the knowledge necessary for self management and medication management working in conjunction with their physicians and other healthcare providers, facilitate an understanding of treatment options and the completion of advanced directives.

GENERAL SUMMARY

: 

The selected candidate will coordinate care for members with various co-morbid disease processes and assume responsibility for case management across the continuum including accessing available resources including telephonic and written communication with physicians and other providers.

ESSENTIAL RESPONSIBILITIES:   

- Initial assessment and screening of members for enrollment into the Condition Management Program;

- Comprehensive and proactive case management of members with chronic conditions to improve patient quality outcomes and decrease costs;

- Follow nursing process and program guidelines including: assessment, establishing interventions related to goals, case plan evaluation; reporting to team, medical directors and other providers; and calculation of cost savings;  

- Assure members receive all necessary care allowed under their benefit plan or alternate funding;

-Work with members and caregivers to understand treatment options;

-Assist members with completing advanced directives;

-Advocate for members to receive care according to members’ wishes;  

- Act as liaison and key resource for Appeals Coordinators for cases involving utilization management, case management, and general medical issues; and 

- Maintain confidentiality of member's information in accordance with HIPAA regulations.

 

 
Qualifications:

JOB SPECIFICATIONS:

Registered nurse with current, unencumbered MO license; BSN preferred, will consider RN with CCM certification and/or at least two years of case management  and relevant clinical experience;  

Must be able to obtain unencumbered license in other States (Coventry will reimburse);

Excellent proficiency with Windows (Outlook, MS Word and Excel) and healthcare software is required.  

Able to document in an accurate and precise manner; 

Excellent verbal and written communication skills