Nurse Case Manager I - Case Management Specialist - Columbus Ohio Region

Job ID : 25-186087Position Type : Full time Location : Looking for Columbus, OH and immediate surrounding counties.Work Type : Field Est. Pay Range : $30.00 / hr. to $32.88 / hr.Position Summary : The Care Manager Specialist is a member of the Care Team. The Care Manager Specialist is responsible for the care management of members that are enrolled in the Dual Special Needs Plan. These members are usually stratified as low - medium stratification, or those with Social Determents of Care needs. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the member's health outcomes, address social determinants of health and connect members with community-based organizations. The Care Manager will assess members' needs as well as gaps in care, communicate with the members' Primary Care Provider (PCP), maintain updated individualized care plans, and participate in Interdisciplinary team meetings. Care Managers will be able to identify members whose needs require clinician involvement and transition members appropriately. Duties : Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals, and interventions. Based on assessments and claims data creates a care plan for members to follow 70% Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the members' health care needs, barriers to care and explore better outcomes for the member 20% Identify and link members with health plan benefits and community resources 5% Perform administrative work to maintain skills needed for job duties 5% 5% Experience : Complete health screening questionnaires, assessments which may be market specific. Support reduction of population of unable to reach members by telephone and in -person visits. Ensure member has filled / received their medication(s) and has an understanding on how to take their ordered medications. Manage caseload of members with current stratification of monitoring, low and medium or those with high social determinants of care needs- frequency / contract guidelines Provides clinical assistance to determine appropriate services and supports due to member's health needs (including but not limited to : Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports) Evaluation of health and social indicators Identifies and engages barriers to achieving optimal member health. Uses discretion to apply strategies to reduce member risk. Presents cases at case conferences for multidisciplinary focus to benefit overall member management. Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member's condition(s) and abilities to self-manage. Coordinates resources, assists with securing DME, and helps to ensure timely physician follow-up. Understands Payer / Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel. Updates the Care Plan for any change in condition or behavioral health status. Provide support to members in transitions of care 2 years LPN Nursing exp, preferred 3 years' experience. Regular and reliable attendance Familiar with community resources & services Strong organizational skills Works independently. Maintains professional relationships with the members we serve as well as colleagues. Communicates effectively and professionally verbally and in writing. Proficient with computer systems Knowledgeable in Microsoft Office Software Excellent customer service skills Has a dedicated homework space Education : HS or equivalent, must be licensed LPNEmployee Benefits : At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits : Four options of medical InsuranceDental and Vision Insurance401k ContributionsCritical Illness InsuranceVoluntary Permanent Life InsuranceAccident InsuranceOther Employee Perks LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.

Salary : $30 - $33