1. Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors.
2. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members' health across the care continuum.
3. Assess the member's health, psychosocial needs, cultural preferences, and support systems.
4. Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes.
5. Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).
6. Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family.
7. Advocate for members and promote self-advocacy.
8. Deliver education to include health literacy, self-management skills, medication plans, and nutrition.
9. Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary.
10. Accurately document interactions that support management of the member.
11. Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
12. Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
13. Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
14. Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals.
15. Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).

Job Types: Full-time, Contract

Pay: $30.00 - $40.00 per hour

Expected hours: 40 per week

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance

Medical Specialty:

Addiction Medicine
Allergy & Immunology
Anesthesiology
Bariatrics
Burn Care
Cardiology
Cath Lab
Critical & Intensive Care
Dermatology
Dialysis
Dietetics
Emergency Medicine
Endocrinology
Forensic Medicine
Gastroenterology
Genetics & Genomics
Geriatrics
Hematology
Holistic Medicine
Home Health
Hospice & Palliative Medicine
Hospital Medicine
Hyperbaric Medicine
Infectious Disease
Internal Medicine
Labor & Delivery
Medical-Surgical
Nephrology
Neurology
Nuclear Medicine
Ob/Gyn
Occupational Medicine
Oncology
Ophthalmology
Orthopedics
Otolaryngology
Pain Medicine
Pathology
Pediatrics
Perioperative Care
Physical & Rehabilitation Medicine
Plastic Surgery
Podiatry
Primary Care
Psychiatry
Public Health
Pulmonology
Radiology
Reproductive Endocrinology & Infertility
Rheumatology
Sleep Medicine
Sports Medicine
Surgery
Telemetry
Toxicology
Transplant Surgery
Trauma Medicine
Urgent Care
Urology
Wound Care

Physical Setting:

Acuity adaptable unit
Acute care
Ambulatory surgery center
Assisted living facility
Birth center
Burn center
Children's hospital
Clinic
Community health center
CVICU
Dental office
ER
High acuity unit
Hospital
ICU
Inpatient
JCAHO accredited facility
Level III trauma center
Level II trauma center
Level I trauma center
Level IV trauma center
Long term care
Low acuity unit
Magnet hospital
Medical laboratory
Medical transportation
Med spa
MICU
Military hospital
Neuro ICU
Newborn nursery
NICU
Nursing home
Operating room
Outpatient
PACU
PCU
PICU
Plasma center
Private practice
Rehabilitation center
School
SICU
Skilled nursing facility
Sleep center
Teaching hospital
Telehealth
TICU
Urgent care center

Work Location: Remote

Kyyba Inc

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