Case Manager, Medicare Programs

Full Job Description

The Case Manager will be responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs and facilitate the member’s overall wellness. Most interventions will be telephonic. The Case Manager will identify members in need and provide education and care coordination to assist them in obtaining needed treatment while removing barriers to service.

This position is responsible for managing Medicare programs and beneficiaries assigned to ACO/MSO primary care provider partners/clients. The activities include but are not limited to:
• Chronic Care Management (CCM)
• High Risk Beneficiary Management
• High-Utilization beneficiary management
• Utilization Management and Transitional Care Management (TCM)
• Enrolling patients into a case management program
• Scheduling patients for Annual Wellness Visit
• Preventive screenings and health maintenance information
• Outbound calls for coordination of care (e.g. Specialists, Home Health, DME, caregivers, etc.)

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES
• Case Manager will be assigned to a population of Medicare beneficiaries
• Case Manager will communicate with the Medicare beneficiaries and Providers for Care coordination
• Ability to create and review care plans for assigned members as needed
• Adheres to Medicare guidelines, quality, and compliance
• Has basic knowledge of Physician offices dynamics and workflows.
• Self-motivated and team player with work ethics and ability to assist in the growth and development of the Health Services team and the company.
• Excellent organizational skills with the ability to manage multiple priorities

POSITION QUALIFICATIONS
• Required: RN, LPN licensed in Florida or MA, CNA or other clinical backgrounds with relevant experience.
• Preferred: 1 year of Case Management or Utilization management experience
• Preferred: Experience with ACO, IPA, Medicare Advantage and/or physician practice
• Must be comfortable working in a multi-cultural environment.
• Willing to work full-time from office as this is not a remote position
• Free of any barriers and distractions impacting assigned tasks
• Must be fluent in English; Spanish-speaking a plus
• Excellent observation, verbal, and written communication skills
• Must be passionate, kind, and comfortable while communicating with seniors and clients

Job Type: Full-time

Expected hours: No more than 40 per week

Benefits:
• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:
• Monday to Friday

Work Location: In person

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