Job description

ESSENTIAL DUTIES and RESPONSIBILITIES:

Telephonically coordinate wellness and disease management, with the focus on diabetes, asthma, COPD, CAD, CHF,

Atrial Fib, HTN and hyperlipidemia, but not limited to this list.

· Contact targeted member for health promotion and restoration by the use of national care guidelines to compare patient’s current level of care with industry standards.

· Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health; create an individual care plan for each patient; provide close follow-up with patients actively managed.

· Work with patients to ensure they have a primary care provider; assist in referrals to specialists if needed; assist in obtaining durable medical equipment, review pricing for high cost drugs.

· Evaluate and make referrals for case management, prenatal program or pharmacology review as indicated.

· Document interventions and patient contact; maintain privacy of member’s records and assist in providing quarterly reports to clients.

· Track groups of high risk members and interventions to show overall health improvement within the organization.

· Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.

KEY COMPETENCIES:

· Strong written and verbal communication skills

· Proficient in Microsoft Excel, Word, PowerPoint and Outlook

· Demonstrate ability to work independently with excellent judgment

· Excellent interpersonal and communication skills including able to give presentations to groups and individuals as needed.

· Good time management skills, highly organized.

QUALIFICATIONS:

Level I-II

· Graduation from an accredited LVN program or AND/RN and possession of a current United States LVN/RN license or a Health education degree. Graduated from as accredited social work program or a certified health coach with additional education. May require additional licensing as business needs change.

· Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience.

· Preferred Bachelor’s Degree

Physical and Mental Requirements:

· Ability to safely and successfully perform the essential job functions with or without a reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.

· Ability to maintain regular, punctual attendance.

· Ability to sit for 6-8 hours.

· Constant use of computer keyboard and mouse; repetitive use of both hands.

· Occasional to frequent twisting of neck; occasional bending of neck and at waist.

This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced or delegated by management to meet the business needs of HealthComp.

Job Type: Full-time

Pay: From $80,000.00 per year

Benefits:

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

Schedule:

• Day shift
• Monday to Friday

License/Certification:

• RN License (Required)

Work Location: Remote

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