Cambridge MA 02141 58 Charles Street
Job DescriptionThis position is a hybrid role acting as both a Clinical Liaison, as well as a Care Manager. This role educates partners, healthcare professionals, community related service providers and potential members about the company and its core capabilities. Involves one on one interaction, presentations, and professional education activities with applicable members and healthcare professionals.
In addition, this role provides care management (avg. 50 caseloads) and assists the Sales and Marketing team to generate revenue and grow membership for the assigned territory. In collaboration with the member’s Primary Care Provider (PCP) and an interdisciplinary team to proactively manage members with complex medical, behavioral and psychosocial needs. Facilitates development, implementation and monitoring of Individual Care Plans (ICP) based on a member’s goals, preferences and disease states. The goal of the ICP is to link members to appropriate care, services, and community resources, promote self-management in order to improve the health status, functioning, community integration and quality of life for members in their preferred place of residence.
- Conducts face to face and telephonic assessments of members’ functional status, medical, behavioral, psychosocial and community resource needs.
- Organizes Interdisciplinary Care Team (ICT) meetings and act as facilitator to ensure that members’ needs are met.
- Develops an ICP based on members’ clinical, behavioral and social needs that incorporates barriers to care.
- Coordinates and arranges for all services required by a member in accordance with the ICP.
- Monitors members’ health status and ensures that member is receiving all necessary medical and supportive services.
- Modifies ICP as appropriate to member’s needs and progress.
- Monitors/manages service utilization to optimize benefits to support access to services that improve health care outcomes.
- Provides utilization management and issuance of appropriate authorizations for covered services.
- Manages care transitions through effective and timely communication necessary for member care and discharge planning.
- Clarifies plan medical benefits, policies and procedures for members, providers and community based agencies.
- Prepares for and participate in clinical case reviews to share best practices.
- Adheres to documentation policies and procedures including documentation of Care Management activities and their effectiveness.
- Maintains a comprehensive working knowledge of community resources, payer requirements, and network services for target population.
- Collaborates with other Care Managers to reduce variations in clinical practice, identifies opportunities for systems’ improvement, and develop policies and procedures relevant to practice.
- Provides backup to other Care Managers as needed.
- Analyzes data and use it to improve care delivery.
- Provides clinical expertise in support of the sales effort by utilizing clinical skills to assist with member sales and referrals.
- Leads the clinical discussion regarding the model of care presentations during Sales and marketing presentations.
- Conducts continuing education programs for sales and marketing and their support staff.
- Engages in the exploration of new ideas and constructive problem solving with the Sales and Marketing Team.
- Maintains and grow relationships with Sales and Marketing staff through customer relationships and provides responsive customer service with assigned accounts.
- Effectively communicates with members and other health care providers and exhibit professional behavior.
- Provides excellent customer service to external and internal customers.
- In partnership with Sales and Marketing, recognizes opportunities for expanding the business relationships with existing members accounts. Provide member education as needed.
- Perform other duties as assigned.
General Job Information
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date4/12/2019
Date Requisition Created4/12/2019
EducationBachelors: Nursing (Required)
License and Certifications - RequiredDL - Driver License, Valid In State - Other, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
- Knowledge and experience of Medicare and Medicaid programs.
- Experience working with a geriatric population.
- Minimum of 2 years of current clinical nursing experience with home care, case management, recent acute care experience, or physician office experience.
- Thorough knowledge of Model of Care.
- Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management.
- Outstanding verbal and written communication skills.
- Strong computer skills; competent in Microsoft Office Product Suite.
- Ability to work independently and maintain flexibly in fast paced environment.
- Ability to analyze data and use it to improve care delivery.
- Self starter with high level of accountability and responsibility for outcome of care.
- Highly organized and able to manage multiple priorities appropriately.
- Independent problem solving skills.
- Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team.
- Minimum of 50% travel within service area.
- Reliable transportation.
- Must be available to cover on-call 24-hours per/day during specific periods.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”