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||AZ - Case Manager
||inVentiv health offers best-in-class Clinical, Consulting and Commercial services to global companies seeking to accelerate performance. With 13,000 employees in 40 countries, we rapidly transform promising ideas into commercial reality. inVentiv has committed itself to hiring and retaining the very best talent in the healthcare industry, those who have a single common characteristic: the desire and aptitude to succeed. We are focused on hiring the best, those who possess unparalleled knowledge and experience as well as a passion for delivering exceptional ideas and service to our clients. In turn, inVentiv provides an opportunity-rich environment where employees can grow as professionals in one of many disciplines and pursue long-term career goals throughout our worldwide network of locations.
We are currently engaged in a search for inVentiv Medical Management, based in Charlotte, North Carolina and a wholly owned subsidiary of inVentiv Health. inVentiv Medical Management has been a pioneer in the world of medical cost containment. We deliver cutting-edge programs and services to set our clients apart from their competitors in the marketplace. Our unique formula combines the expertise of our specialized physicians to create the leading cost containment and medical management solution in the nation, tackling the issues of medical cost and ensuring quality outcomes from a physician’s perspective. This solution not only saves money, but also improves overall patient outcomes, providing the best of both - cost and care. inVentiv Medical Management clients include health plans, employer groups, third party administrators, MGUs and carriers. inVentiv Medical Management has saved its clients nearly $300 million.
Assist patients to achieve optimal health status utilizing the most cost effective quality resources through application of national practice guidelines and Case Management (CM) Standards of Practice. Implement appropriate interventions to manage multiple physical, psychological, social and financial barriers in cooperation with patient, insurance carrier, and medical provider.
Key Job Responsibilities:
Duties may include, but not limited to the following:
- Develop a case management care plan for each patient based on a thorough history and clinical record review, including the attending physician’s plan, the recommendations of national guidelines, in consideration of the patient’s ability to comply.
- Provide case management/utilization review and discharge planning to assure that the patient progresses through the continuum of care and is discharged utilizing the most cost effective quality resources through the application of national practice guidelines and CM Standards of Practice.
- Coordinate the integration of the social service function into patient care.
- Coordinate the hospital activities concerned with case management and discharge planning.
- Adhere to departmental goals, objectives, standards of performance, and policies and procedures.
- Ensure compliance with quality patient care and regulatory compliance.
- Implementation of case management interventions by the application of methods, techniques, behaviors, information and learning aids that positively impact the patient and their condition.
- Organize, secure, integrate and modify the resources necessary to accomplish the goals outlined in the case management plan. Targeted utilization of inVentiv MM specialists and resources.
- Timely creation of quality case management reports documenting results of CM plan interventions in achieving patient-specific goals.
- Facilitation of benefits preservation through coordination of appropriate level of care and plan language compliance.
- Determining Medicare/Medicaid eligibility and/or availability of secondary insurance plan.
- Facilitation of recommended treatments with contracted vendors to preserve patient benefits and facilitate cost containment objectives.
- Comply with inVentiv confidentiality policy, HIPAA requirements and state and federal regulations.
- Function as an effective liaison between patient, third party payer, reinsurance carrier and/or other customers while implementing targeted interventions in keeping with plan language and limitations.
- Functions as a member of a multi-disciplinary team including social workers, dieticians, pharmacologist, and physician consultants.
- Acts as a liaison to providers and community health resources.
- Provides focused education and emotional support regarding identified risk factors on a constant basis.
- Supports the highest level of participant-defined quality of life and well-being.
- Works closely with participant to facilitate understanding of available client benefits and local and national resources
- Business travel may be required. Multi-state licensure may be required.
- Other duties as assigned.
Education / Certification/Registration:
- Must be a licensed Registered Nurse and hold a current, unrestricted license in state of practice
- Bachelors (or higher) degree preferred. Must be willing to obtain Bachelor’s degree with four years to complete.
- Certified Case Manager preferred – Mandatory to apply for CCM certification when eligible.
- Minimum three years industry experience in a managed care setting focused on experience in utilization review/case management and at least two (2) years case management, home care or hospice experience strongly preferred.
- Minimum of Class B driver’s license preferred.
- Ability to interact with a wide variety of people and handle complex situations simultaneously with customer service focus
- Evidence of creativity, integrity and initiative
- Attention to detail and follow-up.
- Experience with electronic clinical charting/records
- Ability to work independently and be self-motivated in a remote environment
- Must practice case management within the scope of licensure (based on the standards of discipline) which includes the knowledge of healthcare benefits and health promotion.
- Manage assigned case load as business needs dictate.
- Excellent time management, flexibility, and efficient organizational skills with ability to work independently and as a team player in both office/remote environment
- Adherence to legal and ethical principles of privacy, confidentiality, safety, advocacy, and accreditation and regulatory standards in all case management activities in both office/remote environment
- Compliance to internal and external goals/metrics established for assigned department
- Position is often required to independently plan and prioritize patient care objectives.
- The ability to analyze and problem-solve
- Proficient computer skills in Windows and Internet use.
- Ability to chart and follow designated workflow(s) in an electronic environment.
- Proficient in typing
- Strong verbal and written communication skills required to meet superior customer service and satisfaction levels.
- Excellent interpersonal skills and ability to function as a member of a multi-disciplinary team.
- Ability to communicate, read, and write fluently in English
- Effective analytical and problem-solving skills.
ACCOUNTABILITY / DECISION MAKING
- Manage assigned case load as business needs dictate.
- Excellent time management, flexibility, and efficient organizational skills with ability to work independently and as a team player.
- Adherence to legal and ethical principles of privacy, confidentiality, safety, advocacy, and accreditation and regulatory standards in all case management activities.
- Compliance to internal and external goals/metrics established in area assigned.
Benefits: At inVentiv health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality of life balance.
EOE: inVentiv health & its Clients are equal opportunity employers and are committed to employing a diverse workforce
|Minimum Education Level