Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.
Coordinate Home Infusion services that achieve optimal benefit and results from the comprehensive management of members with chronic and/or catastrophic illness, members who are frail elderly and/or members whose illness is complicated by challenging psychosocial conditions. Provide focus on transition activities to benefit clinical needs of members. Combine utilization of medical care and pharmacy, with specific focus on the transition of care needs of members from one setting to another and the inpatient setting (acute, SNF/Rehab) to the home setting to ensure coordination of health care delivery, member education, and preventative intervention. Support the site of care that meets the needs of members at the lowest cost.
Responsibilities
• Provide short term care coordination with members, physician, facilities, and home infusion vendors.
• Assess appropriate site of care utilization and continued medical necessity reviews for prior authorization to vendors.
• Ensure communication with MD offices in relation to Site of Care program.
• Track and contact MD identified as providing scope drug in setting that is at a higher level of care than necessary.
• Assist transfer of members from higher level of care to Home / AIS setting for optimal outcomes.
• Create a Medical Drug dashboard reporting the status of volumes and costs.
• Identify and implement cost saving strategies by shifting the patient site of service.
• Develop, facilitate, and communicate discharge plans in partnership with the member, physician and vendor and at times concurrent review team, case management if applicable, social workers.
• Coordinate services from one setting to another, acute setting to home/Ambulatory Infusion Suites throughout the continuum of care.
Qualifications
• Graduate of an accredited 2–4 year nursing program.
• Active, unrestricted license to practice professional nursing, RN (Preferred) or LPN, in the appropriate state.
• Certification as a Case Manager (Preferred).
• 5 – 10+ years of clinical experience in a managed care setting, preferably including acute care experience (Required).
• Ability to use data analytics to drive decision making and strategy (Preferred).
• Experience leading clinical staff (Preferred).
• Prior case management experience (Preferred).
• Communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required).
• Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required).
• Discharge planning experience (Required).
Additional Information
- Job Type: Standard
- Schedule: Full-time
- Employee Status: Regular
- Requisition ID: 1000002050
- Hiring Range: $72,000-$138,000
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.
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