Case Manager, Health Coach

Our Healthcare Insurance client is seeking a Case Manager, Health Coach to join their team for a contract role!

Our client has over 5,000 employees and is the number 1 health insurer in the state of North Carolina, serving more than 3.89 million customers. Health care is changing, and our client is leading the way by providing innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.

Position: Case Manager, Health Coach
Term:  3 + Months
Location: Remote, North Carolina
Hours: One to two times per year, work 1 to 2 Saturdays for 4 hours.  One day per week work an evening which you choose which day. 

Required Skills 

• RN with Associates degree or Bachelor of Science in Nursing (BSN).
• Minimum of 3 years full-time direct clinical experience in an acute medical or acute surgical setting.
• Proficiency with a Microsoft Windows operating system
• Must have valid license to practice nursing within the US and have started application for NC nursing license.

Desired Skills 

• Prior experience in a variety of health care settings is preferred
• Experience with managing and coordinating care for patients who have multiple co-morbidities is preferred.
• Utilization and Quality Management/Outcomes experience preferred.
• Previous work experience with a managed care organization or provider is preferred.
• Prior experience in case management, home health, discharge planning, or concurrent review is preferred.
• For Senior Segment: Experience in responding to the diverse needs of the Medicare population, which includes both over 65 and under 65 aged adults.
• For Commercial Care Management: Multi-State Licensure preferred
• Certified Case Manager (CCM) or Certified Health Coach (CHC) certification is preferred at time of hire.
• For case management roles: those without Certified Case Manager (CCM) certification at time of hire are required to sit for the certification exam within 2 years of employment. Attainment of certification is required within 3 years of employment

Description/Comment:
The Case Manager / Health Coach coordinates the care and services of selected member populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes.

• Serve as a team member on a multidisciplinary team that monitors utilization patterns; identifies and facilitates appropriate health care service delivery for selected members, providers, procedures, and/or diagnoses; and improves the quality and cost efficiency of care and service
• The application of the Case Manager or Health Coachs knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.
• Outreach to members identified as high risk, high cost, or high utilization cases.
• Encourage pro-active intervention to limit expense and encourage positive outcomes.
• Perform a comprehensive assessment of the members health status, educational, and level of support needs.
• Develop a member-centric care plan which includes a self-management plan tailored to members needs, and identification of barriers to meeting goals or plan of care.
• Utilize community resources and funding sources in the development of the plan of care.
• Perform ongoing monitoring and management of member including: scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care).
• Review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• Document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• Complete all correspondence related to case management, including all calls and faxes with phone and fax numbers noted. Obtain consents as indicated.