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Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Job title:
Senior Care Specialist-Clinical Operations Job Description:
Educational Qualifications:
BSN or MSN degree in nursing or equivalent
Professional Qualifications:
Individual licenses in non-compact states
Hold an active Compact nursing license and reside in the state that holds your compact license
Language:
Spanish and English
Summary of Experience:
Minimum of 3 years of clinical nursing experience
Previous adult chronic conditions care management
Previous experience in care management including knowledge of complex care management and care management principles
Experience with motivational interviewing
Experience with MCG or CMS guidelines, assessment and documentation practice
Mandatory Skills:
Intermediate to advanced computer skills as evidenced by ability to navigate multiple systems, utilizing dual computer monitors.
Provide autonomous decision-making, troubleshooting and problem solving related to periodic system issues.
Experience with Microsoft and Excel
Ability to quickly learn and navigate software programs and applications.
Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously.
Effective communication and interpersonal skills.
Effective problem solving and appropriate application of clinical knowledge
Must possess advanced telephonic and virtual communication skills.
Preferred Skills:
Experience with Microsoft and Excel
Purpose of the Role:
The Care manager works closely with members and their caregivers to promote habits to improve quality of life and attainment of health goals using a Whole Person Care approach. The Care Manager creates a customized plan to meet the clients’ key risks through collaborative approach with the clients and their caregivers.
The Care Manager is responsible for developing a health coaching relationship with members and assisting the member through the process of actively working towards better health by providing support, encouragement, and education on chronic conditions. The Care Manager supports coordination of care and condition management activities with members, caregivers, and providers.
Roles & Responsibilities:
Telephonically assess Medicare, Medicaid, and/or and Group Account members and create actionable and measurable care plans to help guide and track the members' progress toward goals
Use nursing judgment to assess and coordinate care for acute situations (APS, EMS)
Discuss transitions of care to assist with safe discharge to the home and coordinate care for DME, home health, provider appointments, etc.
Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
Assess member’s physical, environmental and psycho-social health issues and work in collaboration with a multi-disciplinary team, such as social workers, dietitians, pharmacists, etc., employing a variety of strategies/techniques to manage appropriately and provide timely intervention
The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned
Location:
Work@Home USAUnited States of America Originally posted on Himalayas
