HireDiversity

Description:
Coventry Health Care is currently seeking a Complex Case Manager for our Kansas City; MO location. The Condition Management Program case management model focuses on chronically ill members using the latest technology. The ideal candidate will have experience with CHF and COPD; and a clinical familiarity with a culturally diverse and aged patient population is preferred. This position will incorporate the use of telemonitoring to help members manage their daily symtoms and develop the knowledge necessary for self management and medication management working in conjunction with their physicians and other healthcare providers.



GENERAL SUMMARY

: The selected candidate will coordinate care for members with chronic heart failure; COPD; and other co-morbid disease processes and assume responsibility for case management across the continum 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; - 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 licence; 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 are a must. Must be flexible and able to function independently and efficiently in a managed care for-profit environment while working cooperatively with other team members. Please submit your resume and salary requirements.

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Professionals
Primary Location: Kansas City, MO, US
Organization: 10000 - Coventry Health Care - Corp
Schedule: Full-time
Job Posting: 2012-10-29 00:00:00.0
Job ID: 1211937