PURPOSE OF CASE MANAGER POSITION:
The Case Manager is a patient advocate, who is an integral part of a cross-functional clinical team comprised of clinical coordinators, physicians and other nurses that facilitates the delivery of healthcare information to Medical Confidence patients. This case management position focus is to ensure clinical quality and the highest level of patient’s satisfaction on all cases across the full spectrum of Medical Confidence service lines
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:
Utilizing experience of nursing process, case management standards of practice guidelines and medical resources interpret medical records and test results and provide assessment accordingly to provide proactive case management services; including:
- To facilitate quality case management services in an appropriate, cost effective manner.
- Document all contacts and outcomes related to case activity in system. Submit billing reports on all activities per established guidelines;
- Responsible for oversight and management of all cases as they progress through various stages of the Medical Confidence services;
- Obtain a comprehensive health history by leading patients through a systematic and dynamic intake assessment to capture all relevant data about their current condition and health history including medical records from providers, following up with written correspondence if necessary;
- Direct patients to the most appropriate Medical Confidence service based on their medical condition by utilizing current scripting; set appropriate patients expectations for each process;
- Prepare the case for review by Medical Confidence Physician team;
- Collaborate and confer with Medical Confidence Physician team to understand their opinion with respect to diagnosis and treatment assessment, recommendations of follow-on care for the patient specifically additional testing and appointments with physician specialists;
- Prepare written evaluative reports, denoting case activity, progress and recommendations in accordance with Medical Confidence regulations and standards;
- Utilize the company’s proprietary database to help connect patients to Medical Confidence associated physicians & specialists for appointments;
- Work with patient’s Primary Care Provider to receive referral for the Physician Specialists and any necessary testing;
- Work with Physician Specialists’ offices and Labs and Imaging Departments to ensure patient is scheduled for the first available appointment and confirm with Patient and Patient’s Primary Care Provider of appointments;
- Provide case updates to Patients while providing exemplary customer service including Conduct patient’s health coaching and provides treatment support service;
- Demonstrate ability to meet administrative requirements, including productivity and time management with a minimum of supervisory intervention;
- Maintain his/her own availability within his/her set shift for scheduling of patient intakes via outlook and live telephone transfers;
- Review case with supervisor to evaluate files and obtain directions and escalates questions/concerns regarding cases to Physician, Specialist, Nurse Manager and/or Medical Director;
- May perform other related duties as assigned.
DESIRED MINIMUM QUALIFICATIONS:
Education and Experience-
- Bachelor’s degree in nursing
- Registered Nurse
- Health Plan experience preferred
- 3 to 4 years’ experience in a professional office environment; hospital, physician, or other medical environment preferred
- Medical records department experiences a plus.
- Previous case management experience preferred, in particular legal case management
- Insurance claims experience an asset
- Excellent written and verbal communication skills
- Outstanding team player & strong interpersonal skills
- Bilingual is a plus
- Strong organizational skills and the ability to multitask with ease
- Strong clinical knowledge base
- Quality driven with a focus on flawless customer service
- Ability to work independently but recognize when escalation is warranted
- Proficiency using technology and software programs including Microsoft Word, Excel, Outlook.
Medical Confidence was founded for the sole purpose to help individuals receive the best possible healthcare. Helping you navigate the...