Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Case Manager, Health Management - NYC Program
Summary: To facilitate the accurate administration of benefits, maximize optimal appropriate utilization related to medical necessity, and place of service to foster high quality care in cost effective environment.
Responsibilities:
• Communicates and evaluates medical management strategies including potential for alternatives with multidisciplinary team (including member/family and provider/physician organization). Coordinates activities of multidisciplinary team involving providers and family members.
• Manages high profile City of NY gold card clinical program members in conjunction with clinical staff at Embelm Health supporting the City of NY account or other key high profile customers for CMSI
• Responsible to provide counseling and guidance to health coaches on clinical matters and jointly decide best care coordination, or counseling for the participant allowing for smooth transitions between nurse and health coaches at CMSI and Emblem
• Performs prospective case management to reduce/avoid emergency room and hospital utilization.
• Provides telephonic coaching, counseling, consultation and information and referral services to participants managing various chronic health conditions
• Provides education regarding appropriate preventive care.
• Promotes wellness by coaching, motivating and educating participants to attain maximum mental and physical well being.
• Enters and maintains critical data in information management system. Manages databases to assure accurate and timely reporting. Works collaboratively with physician organization, in the analysis and dissemination of utilization/case management information.
• Maintains current “state of the art” working knowledge of his/her nursing specialty, CCI products & benefits, and related computer programs through continuing education, community resources and publications.
• Expected to manage a flexible work schedule in order to meet the needs of participant and to optimize reach rates.
• Actively participated in new provider orientations, and ongoing provider and participant education programs.
Qualifications:
• RN License in New York and CT .
• Bachelor’s Degree in nursing required or an equivalent combination of education and experience.
• Minimum of 4 years of clinical experience.
• Minimum of 1 year experience in an HMO setting preferred.
• Strong oral and written communication skills.
• Computer literacy on Windows products.
• Presentation, organizational and negotiation skills.
• Health insurance background preferred.
• Possible New York travel.
• Bilingual Spanish or Chinese preferred.
• Hours maybe outside CCI hours or CMSI weekends or evenings possible.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.