Cvs Health Utilization Management Remote Jobs in Nebraska

Remote Care Manager

Location: Remote

The Care Manager will be assigned a patient panel based on skill and efficiency level and is expected to carry a patient panel of a minimum of 30- 50 patients per calendar month within the first three months of assignment (depending on patient availability at the assigned practice location). Care Managers are expected to complete due diligence on 100% of their assigned patients and complete billable encounters on 90% of the patients they are assigned each month unless patients are unable to participate due to current health conditions.

Compensation Structure

Esrun Health utilizes a productivity-based pay structure:

$10.00 per completed patient encounter up to 99 encounters/month.

$10.25 100-149 encounters/month

$12.00 150-199 encounters/month,

$14.00 200-249 encounters/month

$16.00 >250 encounters/month.

Payment tier increases require 2 months consistency to achieve and are awarded in third month.

There is a $1/encounter incentive compensation for bilingual contractors equal to $3/hr but is only applied if hired into a bilingual position.

• Monthly outreach will consist of cumulative time to include chart review, contact attempts (calls/texts/emails), actual call time, care coordination, and documentation/billing.
• This time is billed out in 20-minute units of service referred to as "encounters" and each patient can be billed for up to three units of service or "encounters" each month.
• (20-39m=1 encounter, 40-59m=2 encounters, >60m=3 encounters)
  • EXAMPLE: Chart Review 8 min

Outreach Attempts: 6 min

Actual Call:11 min

Care Coordination:9 min

Total Time Spent:44 min = 2 encounters

• As a productivity-based position - there is no compensation outside of the billable encounters described in the compensation structure other than goal bonuses, referral bonuses, and employee engagement activities resulting in monetary prizes.
• There is no pay for onboarding until care manager completes billable encounters. Onboarding is self-led and can be completed in as little as 3 days (2-3hrs total time for initial orientation and 1-2 days for workflow training once assigned) - but can, depending on individual schedule, take up to 14 days.

What your impact will be:

• The role of the Care Manager is to abide by the plan of care and orders of the practice.
• Ability to provide prevention and intervention for multiple disease conditions through motivational coaching.
• Develops a positive interaction with patients on behalf of our practices.
• Improve revenue by creating billable Care Management episodes, increasing visits for management of chronic conditions.
• Develop detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes.
• Understand health care goals associated with chronic disease management provided by the practice.
• Attend regularly scheduled meetings (i.e., Monthly Clinical Update Meeting, monthly 1:1 with supervisor, etc.). These "mandatory" meetings will be important to define the current scope of work.

What we are looking for:

• Graduates from accredited Schools of Nursing (LPN, LVN, RN, BSN, etc.)
• Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no disciplinary actions noted or licensed in the non-compact state where the applicable practice is located.
• A minimum of two (2) years of clinical experience in a clinic setting, Med/Surg, Case Management, and/or home health care.
• Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (Microsoft Office 365, Teams, Excel, etc), also while being in a HIPAA compliant area in home to conduct Care Management duties.
• Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills.
• Ability to quickly learn new technology through video tutorials and resources in a self-led environment
• High Speed Internet (Minimum Download - 18mbps/Upload 6mbps) and either a Desktop or Laptop computer in good working order (Has to be operation system of Windows or Mac) NO Chromebooks, iPads, or tablets
• Excellent verbal, written and listening skills are a must.

What will make you stand out:

• Quickly recognize condition-related warning signs.
• Organized, thorough documentation skills.
• Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills.
• Clear diction. Exemplary phone etiquette applies to every call.
• Committed to excellence in patient care and customer service.
• Ability to troubleshoot minor technological issues related to remote working environment.

What we offer:

• Streamline designed technology for your Chronic Care operations
• Established and secure company since 1976, providing critical software solutions for many verticals in countries ranging from North America, Europe, Asia, and Australia.
• Core Values that unite and guide us
• Autonomous and Flexible Work Environments
• Opportunities to learn and grow
• Community Involvement and Social Responsibility