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.
Field Care Manager
Summary of Job: Professional clinician (RN), who in collaboration with health care providers, supports and enables members to manage their physical, environmental and psycho-social concerns, understand and appropriately utilize their health plan benefits and remain safe and independent in their home or current living environment. As part of a multi-disciplinary care team providing care, with responsibilities that include care coordination, performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating authorization and concurrent review processes and coordinating implementation of interventions.
Responsibilities:
• Work with the care management team collaborating with members, caregivers, providers, Total Population Health (TPH) multi-disciplinary team, health care and community resources to evaluate member needs through a variety of assessments. Identify areas of (medical, financial, environmental, health insurance benefit, social determinants, caregiving concern and potential gaps in care at the face to face in home visit.
• With the member, caregiver, provider(s) and TPH multidisciplinary team, develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care.
• Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate.
• Work collaboratively with the entire care team to ensure knowledge of the action plan in support of the patient care plan, to include participation in case conferences.
• Document and maintain assessment and intervention data in appropriate applications and platforms.
• Comply with all performance standards and reporting requirements.
• Maintain an understanding of the clinical program design, implementation, and management, monitoring, and reporting.
• Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards.
• Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and ConnectiCare standards.
• Maintain an understanding of TPH principles, program objectives and design, implementation, management, monitoring, and reporting.
• Perform other related projects and duties as assigned.
Qualifications:
• Graduate of accredited professional registered nursing program
• Current unencumbered license to practice professional nursing in the State of Connecticut
• Prior case management/care coordination and Home health care experience required
• Prior Knowledge of Medicare/Commercial insurance required
• Certification in care management a plus
• Experience working in physician practice and/or with electronic medical records preferred
• Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.)
• Strong analytical, organizational, oral and written communication and computer skills
• Bilingual in English/Spanish or English/Polish preferred
• Presentation, organizational and negotiation skills
• Must provide own transportation to member’s homes and other sites of care delivery for patient interaction
• Manage a flexible work schedule to meet patient and/or caregiver scheduling needs
Essential Job Requirements:
• Must be able to routinely drive own vehicle.
• Travel required 100% of the time for member assessments.
• Must be flexible in work schedule to meet members’ needs.
• Must be able to use standard office equipment.
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.