Description

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

OPPORTUNITIES AVAILABLE IN ANY STATE WITHIN THE U.S.

Job Summary:

Performs all functions delineated in the CSH Care Management Program description, including activities and projects in support of Quality Improvement.

Main Accountabilities:

• Serves as Member advocate, assessing and assuring quality care is given.
• Identifies high risk factors, barriers to goals, and strengths that will assist the Member in achieving goals.
• Assists the Member in managing their health conditions, prioritizing their health care needs, and preventing complications.
• Coordinates care in conjunction with multidisciplinary healthcare team, the Member, and other providers.
• Provides timely reviews of the care plan with the Member as necessary, re-evaluates and modifies the plan of care based on Member outcomes.
• Regularly communicates with the Member to maximize care opportunities.
• Provides self-management support to the Member and refers to other resources as appropriate.
• Provides necessary and appropriate education materials to the Member.
• Conducts telephonic and other outreach to the Member before, during, and after specific healthcare interventions, in order to facilitate services and/or follow-up care.
• Provides and ensures accurate clinical documentation in the care management system.
• Promotes effective and efficient utilization of clinical resources and services.
• Establishes and maintains collaborative relationships with internal team members and external providers.
• Partners with team in the evaluation and support of quality initiatives (HEDIS and STARS).
• Promotes team environment.
• Other tasks and duties as assigned.

Qualifications:

• Licensed Registered Nurse.
  • NLC license or Licensed in Georgia AND South Carolina
• 1-3 years Managed Care experience in Care Management.
• Working knowledge of Medicare Advantage plans.
• Bilingual strongly preferred.
• CCM certification strongly preferred.
• Strong analytical skills.
• Strong computer skills – Microsoft Office Suite.
• Strong communication and interpersonal skills.