Description
Do you wake up every morning inspired to solve problems and make a meaningful impact in healthcare? If so, we want to hear from you.
At Innovista Health, we're leading the effort to drive transformative change in healthcare. We are a full-service value-based care and managed service organization that partners with independent providers to help them navigate, succeed, and thrive in value-based care.
Founded in 2013, Innovista Health offers solutions for providers at every point along the continuum of value-based care, ranging from care management, provider/ACO enablement, and quality improvement to performance insights, reporting, and managed administrative/payment services.
We're thrilled to announce a dynamic opportunity for you to become an integral part of our Texas team. As an on-site contributor, you'll play a key role in pioneering a pathway toward a more streamlined and effective healthcare system.
JOB SUMMARY:
The role of the Clinical Case Manager is to coordinate continuity of care for patients often as a liaison between the patient’s family and healthcare organization, ensuring that the proper treatment is administered at the appropriate time to maximize health and well-being while also minimizing the need for hospitalization. The Case Manager strives to promote self-managed care and the use of healthcare resources in the most cost-effective way possible, working with patients of all ages and conditions but primarily focusing on a specific population. The individual in this position has overall responsibility for overseeing the clinical care plan to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.
DUTIES AND RESPONSIBILITIES:
- Implements a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.
- Identifies members appropriate for Case Management by use of targeted chronic conditions, level of care, and recognition of member’s condition-specific and preventative measures, knowledge base, or deficits in monitoring health, wellness, and chronic conditions.
- Provides transitional care management, coordinating post-hospital care to prevent readmissions.
- May perform on-site and telephonic continued stay review on members at predetermined intervals during facility stays to collect in-depth information regarding the member’s situation, functioning, and needs assessment in order to develop a comprehensive Medical Management Plan and Discharge Plan.
- Determines appropriate level of care and place of service based on the medical information available and criteria application.
- Collaborates with Medical Director when appropriate to ensure appropriate, coordinated service delivery.
- Identifies members requiring post-hospital services and initiates discharge planning with attending physicians and designated hospital personnel.
- Coordinates appropriate post-hospital services.
- Collaborates with the Provider or their designee to address the care plan from an integrated approach.
- Implements, monitors, and closes the care plan to determine if the goals are being met on an ongoing basis to evaluate for needed changes and update the plan of care accordingly.
- Conducts outbound calls to members to complete telephonic assessments and provide interventions and education for the management of members’ health, wellness, and chronic conditions.
- Reviews and analyzes clinical indicators and whether there is any ‘gap’ in compliance with quality of care.
- Identifies and reports quality of care issues to the Medical Director and the Director of Population Health Management.
- Completes clear and concise documentation in Care Management programs.
- Prepares, participates, and presents CM/DM reports to UM/QM Committee as requested.
- Collaborates with the internal staff to support and uphold the established guidelines and NCQA standards.
- Maintain personal professional development within clinical expertise.
- Participate in departmental and company in-services, meetings, and/or conferences as appropriate.
Requirements
- Bachelor’s degree or equivalent experience required.
- At least 3-4 years of relevant professional experience.
- Registered Nurse (RN) licensure in the state of Texas or compact nursing license required.
- A certified Case Manager (CCM) is preferred.
- Knowledge of disease pathophysiology, psychosocial issues, and treatment.
- Proficient in MS Office Applications and ability to learn department and job-specific software systems.
- Able to effectively communicate case management concepts with team members and clinical concepts and program outcomes with team members and internal customers.
BENEFITS
We are committed to creating a culture where everyone feels important, welcomed, and included. We demonstrate this commitment by offering a comprehensive benefits package that fosters opportunities for growth and advancement and supports the physical, mental, and financial wellbeing of our team members.
HEALTH & WELLBEING
- A choice of health coverage, including HMO and PPO, plus Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
- Dental and vision coverage.
- Company-paid benefits (short- and long-term disability, employee life, and accidental death and dismemberment).
- Employee Assistance Program.
- Discounts and perks on gym memberships, shopping, travel, recreation, and more.
FINANCIAL GROWTH
- A yearly discretionary bonus.
- 401(k) with a company match.
- Rewarding employee referral bonuses.
WORK/LIFE BALANCE
- Generous paid time off policy that increases with tenure.
- Nine paid company holidays + three Diversity Days.
- Paid Parental Leave (up to 6 weeks, subject to applicable waiting period).
- Potential to work hybrid or remote and/or create a flexible work schedule (role specific).
JOB SATISFACTION & ADVANCEMENT
- Clear career advancement and growth pathways.
- Continuous education opportunities.
- Diversity, Equity & Inclusion Committee with various Business Resource Groups you can join.
- Company-wide socials and gatherings.
- "Dress for Your Day" policy.
- An open-door policy that encourages direct communication with our CEO and upper management, fostering transparency and inclusivity in our work culture.
Benefits may be subjected to an applicable waiting period.
#J-18808-Ljbffr
