Care Manager II - Tigard

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies.  Health Net’s mission is to help people be healthy, secure and comfortable.  The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals.  For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com

 

JOB SUMMARY:

 

The Care Manager II is responsible for providing care management services to beneficiaries with planned admissions to acute care hospitals, or to those transitioning from case management or disease management programs. Systematically identifies and addresses fragmented care for patients with acute, real-time needs and tailors interventions and services to fill gaps and produce optimal clinical outcomes.

May also conduct Quality Assurance audits, monitor and oversee workflow, review and maintain policies and procedures, and perform system testing of modifications and enhancements.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

Pre-Admission CounselingContacts patients with upcoming hospital admissions and discusses expectations.  Assesses patient’s condition to understand illness or injury and evaluate ability to follow treatment plan.Advises patients of probable length of stay and helps anticipate and arrange for services at discharge.

Admission CareWorks with physicians and hospitals to enforce treatment plans and orders.Ensures patient receives specialty care and tests as ordered.Contacts medical team members to discuss patient’s course of progress and needs.Arranges for and coordinates health care team services, avoiding duplication and conserving benefit dollars.Evaluates need for and authorizes equipment, supplies, services.Identifies problems and instructs patient and family in proper care and refers patient back to physician or other health care team members.Identifies plateaus, improvements, regressions and depressions, and counsels accordingly.

Coordination of CareConducts hospital visits.Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information.Authorizes recommended modalities of treatment. Investigates and suggests alternatives.Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers.Facilitates beneficiary transfers among regions and collaborates with military liaison to minimize disruption care or services.Coordinates basic benefit. Identifies and submits modifications, requests for exceptions or special programs.

Coordination of Financial ServicesAssesses patient’s benefit plan coverage and limitations.Negotiates rates for provider services by contacting multiple providers and comparing specialty item costs, researching and identifying required equipment, and pursuing contracts.Suggests medical alternatives that accomplish treatment plan goals.

Post Discharge Follow-upContacts patients within 48 hours of discharge to ensure sufficient support for full recovery.Ensures proper receipt of equipment, home health and other services.Assesses compliance with medications and follow-up appointments.Assists patient in coordinating transportation and other basic needs, and in navigating the health care system.

Associate TrainingOrganizes, schedules and conducts program and skill training for Care Management associates.Identifies and maintains ongoing training needs and designs training plans. Develops care management policies and procedures, and facilitates and recommends process improvements.

 

REQUIREMENTS:

 

Education:
Graduate of Nursing program, BSN Degree preferred.

 

Certification/License:Valid and active State of Oregon Registered Nurse licensure required.State of Oregon Driver’s License



Experience:Five years clinical experience in a health care environment; including Care Coordination, Nurse Advice/Triage, Case or Disease Management. Managed care experience preferred.Internal candidates must have functioned as a Case Manager I and received a satisfactory score on the Advancement Exam.

Knowledge, Skills & Abilities:Exceptional written and oral communication skills.Demonstrated ability to assess, evaluate and interpret medical information.Skilled in computer operation with proficiency in Microsoft Office Word.Excellent Interpersonal skills and ability to work effectively and independently.High level of understanding of community resources, treatment options, home health availability, funding options and special programs.

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. 

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.