Integrated Care Manager
Company: Oak Street Health
Title: Integrated Care Manager
The mission of Oak Street Health is to rebuild healthcare as it should be.
We are a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare.
The Oak Street model integrates outstanding clinical expertise, technology, and teamwork to deliver improved care quality and cost savings. These cost savings are then reinvested into care in our communities, creating a virtuous cycle of improving community health.
We are a national organization serving over 100,000 patients and we are growing rapidly. We are a diverse team of care providers, service team members, technologists, community outreach experts, business professionals, and more -- all dedicated to our Oaky Values and motivated by our mission. We’re looking forward to getting to know you!
For more information, visit www.oakstreethealth.com.
The Care Manager is a key member of the care team, contributing to the support and social service needs of our patients. As a part of the care management team, you would be managing care to an underserved area of the community that includes all cultural components. You will serve as the primary case manager, providing assessment, advocacy, and case management services to individual patients and their caregivers, in an effort to help patients maintain or improve their health status and avoid hospitalizations. You will be expected to carry a caseload, build relationships with Oak Street Health patients, manage patient’s care plans, perform proactive phone and in-person outreach and assessments to our patients based on their care needs. You will also participate in and lead Care Team decision making in care team meetings and generally coordinate all clinical and auxiliary services needed to provide a high quality health care experience from Oak Street Health. Individuals in this position demonstrate cultural sensitivity, effective communication, and motivational interviewing skills.
Manage an assigned caseload while remaining in compliance with all internal and regulatory requirements
Create and nurture relationships with all assigned members working towards their optimal overall health and well-being
Be the system navigator and point of contact, in collaboration with the care team, for members and families
Conduct complete, timely, and accurate program specific assessments (face-to-face and telephonic)
Develop and maintain a person-centered care plan or family driven care plan for all members in assigned caseload involving the member’s PCP, family/caregiver, Social Worker, Behavioral Health Specialists, and other specialists, as needed, to evaluate the individual’s needs, goals, and plan of action
Complete all activities and interventions outlined in the members care plan and ongoing monitoring of cases to ensure routine follow up and progression in their care plan goals
Document visits in electronic health record according to standards set forth in contracts
Schedule and maintain interdisciplinary care team (ICT) meetings. Occasional meetings to be held on site at OSH center
Capacity to transport oneself to members’ homes (if needed) and facilities and comply with travel and mileage reimbursement policies
Facilitate ICT activities with members and their identified support team and maintain strong communication with the member’s care team
Maintain HIPAA standards and confidentiality of protected health information
Other duties, as assigned.
What are we looking for?
Bachelor's degree or minimum of 2 years of relevant experience required
HMO /Managed Care setting preferred
Knowledge of community resources in assigned service area
Knowledge of clinical standards of care preferred
Knowledge of Medicaid/Medicare contracts and benefit systems is preferred
Demonstrated customer-focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary care team, community agencies, members, and families with diverse opinions, values, and religious and cultural ideals
Ability to work autonomously, follow through with delegated tasks and be directly accountable for deliverables
Outstanding verbal and written communication skills
Ability to work independently and maintain flexibility in a fast-paced, start-up environment
A high-level of accountability and responsibility for the outcome of care
Excellent interpersonal and facilitation skills
Ability to affect change, work as a productive and effective team member, and adapt to changing needs and priorities
Excellent organizational skills and ability to manage multiple priorities appropriately
Independent problem-solving skills
A flexible, positive attitude
Experience working with the communities we serve
Access to reliable transportation and ability to travel daily
Working knowledge of Microsoft Office Product Suite
Working knowledge of Google Suite
US work authorization
Someone who embodies being “Oaky”
What does being “Oaky” look like?
Radiating positive energy
Assuming good intentions
Creating an unmatched patient experience
Driving clinical excellence
Taking ownership and delivering results
Why Oak Street?
Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:
Collaborative and energetic culture
Fast-paced and innovative environment
Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits
Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers.