Overview
InnovaCare Management Services Company, LLC. InnovaCare Health operates nearly 40 clinics across Florida and Texas. We are a physician-led healthcare organization focusing on value-based care, transforming care delivery through technology and coordinated care. We are seeking hard-working, career-minded individuals to join our team to fulfill our mission of improving patients’ lives daily.
Job Summary
The Care Manager (CM) promotes patient quality of care and cost-effective outcomes through assessment, planning, facilitation, care coordination, and evaluation of comprehensive health needs. The CM collaborates with clinical staff inside and outside of InnovaCare and with contracted insurance companies.
Essential Job Functions
Utilize clinical tools, data, and other information to complete patient needs.
Create individualized and comprehensive needs assessments for care management and treatment plans.
Document all treatment plans, tasks, and actions into the EMR when applicable to meet turnaround times as documented in policy and procedures.
Collaborate with Utilization Management (UM) staff in transition of care protocols to avoid readmissions and to meet CMS STAR measures for transition of care (TOC) and Medication Reconciliation.
Validate prescribed treatments and treatment plans with patients to ensure understanding and adherence.
Educate patients on available support services, including social work programs, insurance company services and benefits, and other community resources to meet social determinants of health (SDOH) needs.
Collaborate with patients, providers, and insurance companies for successful healthcare outcomes and to manage chronic and high-risk conditions.
Document complex medical information that outlines how to improve health results and educate patients on Advanced Directives.
Monitor and evaluate patients on an ongoing basis.
Follow care and quality management processes in compliance with regulatory guidelines and company procedures.
General Knowledge/Skills
Must: Critical thinking and problem-solving skills.
Preferred: Clinical knowledge of chronic conditions, management of high-risk patient populations, and knowledge of available community resources.
Strong knowledge of managed care concepts.
Strong written and verbal skills with patients, physicians, and other stakeholders, including facilitating patient engagement in their healthcare.
Ability to timely assess and respond to patient and family needs.
General knowledge of care (case) management practices, including familiarity with Medicare Advantage products, programs, and services.
Experience in establishing professional and collaborative relationships with patients, providers, and insurance organizations.
Basic computer skills, including working knowledge of the Microsoft Office suite.
Not required, but preferred: Certification as a diabetes educator, nutritionist, social worker or other specialty.
Minimum Required Education, Experience & Skills
Current Nursing License within the state in which you work or Compact License; RN preferred, may consider LPN with Managed Care experience outside of a clinical setting.
Minimum two years clinical practice, one year care (case) management experience, or will work towards and maintain a Care (Case) Management Certification.
Continuing education in Care (Case) Management and all other applicable professional licensure.
CPR/BLS certification.
Environmental and Working Conditions
The position is in an office setting requiring sitting, walking, talking, and listening. A valid driver’s license is required and travel is expected approximately 30% of the time.
Required immunizations and vaccinations.
Ability to lift up to 50 pounds.
Ability to push or pull heavy objects using up to 100 pounds of force.
Ability to stand or sit for extended periods.
Fine motor skills to operate equipment and/or machinery.
Ability to drive and operate a vehicle.
Ability to receive and comprehend instructions verbally and/or in writing.
Ability to use logical reasoning for problem solving.
Occasionally exposed to communicable diseases or bodily fluids.
Occasional travel for clinic activities may be required.
The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management reserves the right to alter this job description at any time without notice.
EEO and Additional Information
We are an equal opportunity employer. Referrals increase your chances of interviewing at InnovaCare Health. Sign in to set job alerts for relevant roles.