What are the responsibilities and job description for the Bilingual Case Manager (RN) position at Insight Global Healthcare?
Job Description
Job Description
PLEASE NOTE : This role is remote but will require face-to-face visits, so candidates must reside in El Paso.
Requirements :
RN (TX) License
1 years of experience working with individuals with chronic illnesses, co-morbidities, and / or disabilities as a Service Coordinator, Case Manager, or similar role.
1 years of experience working in a community health, clinical, hospital, acute care, direct care, or case management setting.
Ability to travel in the assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals, etc.
Reliable transportation with a valid driver’s license and good driving record.
Bilingual – Spanish.
Day to Day :
Conduct telephonic or face-to-face holistic evaluations of members' individual dynamic needs and preferences, gathering relevant data and obtaining further information from members / families.
Provide education and support to members / LAR on options of Consumer Directed or Service-Related delivery models as applicable.
Perform initial assessments, follow-up assessments, and outreach calls within the time specified as part of contractual guidelines or per member / family / provider request.
Identify members for high-risk complications and coordinate care with the member and the healthcare team.
Manage members with chronic illnesses, co-morbidities, and / or disabilities to ensure cost-effective and efficient utilization of health benefits.
Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care.
Utilize both company and community-based resources to establish a safe and effective case management plan for members.
Collaborate with members, families, and healthcare providers to develop an individualized plan of care.
Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services.
Manage care plans throughout the continuum of care as a single point of contact.
Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the healthcare team.
Utilize approved clinical criteria to assess and determine the appropriate level of care for members.
Document all member assessments, care plans, and referrals provided.
Participate in interdisciplinary team meetings and utilization management rounds, providing information to assist with safe transitions of care.
Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as they apply to the health plan.
Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting member needs.
Report medically complex cases to appropriate roles as necessary for review and problem-solving.
Maintain status on face-to-face and telephonic visit requirements for assigned members.
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