Episodic Case Manager

Essence Healthcare is a physician owned plan that has been organized to operate as a Medicare Advantage Plan serving the greater St. Louis Metropolitan Area.  Essence offers comprehensive benefits specifically designed to serve aging Medicare patients.  We offer our members a simple way of achieving better healthcare.

DESCRIPTION: This position involves the ability to assess, plan and facilitate options and services to meet the members’ needs within the benefit plan. It requires the ability to use available resources in a timely manner to promote high-quality cost-effective care. The case manager is responsible to work collaboratively with the member, physician, and healthcare team in order to obtain optimum value for both the member and the plan. This position applies the standards of practice and performance in the work setting to achieve positive outcomes and ensures the performed activities are in compliance with all applicable federal and state regulations.



QUALIFICATIONS: Effective licensure as a registered nurse in the state of Missouri and Illinois.  Three years minimum experience acute care setting is required. A minimum of three to five years’ experience in field of case management is required. Experience with medical criteria a plus; CCM preferred. Must be proficient with computers, have excellent interpersonal and customer service skills, including telephone etiquette. Must be able to multi-task and prioritize on a daily basis.



RESPONSIBILITIES:



Liaison between Essence and patients/membersMember/patient advocateEpisodic case managementDischarge planning of acute patientsRefer members for complex case managementEntry of data into Facets Perform referrals and pre-authorizationsIdentify quality issues

We offer competitive salary and excellent benefits, Including 401k, EOE



 

Please Apply at http://www.essencecareers.com