Interqual Jobs in Chicago, IL (NOW HIRING)

About Zing Health
Zing Health Holdings, Inc. is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

JOB DESCRIPTION

The Integrated Care Manager will be responsible for conducting health risk assessments, coordination of care and care management for MAPD, C-SNP and D-SNP members.

Fundamental Components includes but are not limited to:

• Coordinates care for members utilizing CMS & Zing Health approved medical necessity screening criteria (i.e., NCD, LCD, InterQual, etc.).
• Coordinates ancillary services as needed (home health, DME, etc.).
• Follows patient through various transitions of care to ensure that any gaps in treatment plans are identified and remedied and promote efficient health care delivery.
• Participates in assessment activities to develop individualized plans of care in coordination with patient, family, and providers.
• Applies case management standards of practice to focus on effective care of high-risk high-need patients.
• Serves as a patient advocate and resource and provides critical information and recommendations to the rest of the care team.
• Maintains strong knowledge of UM, Case management, community resources and plan benefits to promote improved member experience and health outcomes.
• Works collaboratively with the member (and caregivers), primary care physicians, specialists, and other care providers to ensure member compliance and adherence to medical plan of care.
• Assists Health Services Team in implementing best practices for chronic care and disease management.
• Follows standard protocols, processes, and policies. 
• Provides member education to assist with self-management and encourages members to make healthy lifestyle changes.
• Interacts with Medical Directors, Pharmacists, Behavioral Health Clinicians, and Other Impact Team Members on challenging cases
• Makes referrals to outside sources.
• Documents and tracks clinical reviews, member care plans, referrals, and findings.
  
• Performs other duties, projects and actions as assigned

Qualifications Requirements and Preferences:

• • Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Licensed Professional Counselor (LPC), Licensed Clinical Professional Counselor (LCPC), Licensed Master Social Worker (LMSW), Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW) OR Licensed Mental Health Counselor (LMHC) with 3 years direct clinical care to the consumer in a clinical setting.
  • Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
  • 3 years of wellness or managed care experience presenting clinical issues with members/physicians.
  • Demonstrates strong clinical knowledge, ability to perform clinical assessments on Cardiology patients, ability to use critical thinking skills and has the capacity for continued learning.
  • Knowledge of UM and plan benefit designs.
  • Demonstrated ability to perform case management & disease management activities.
  • Ability to demonstrate knowledge of and apply those to the job function and responsibilities.
  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
  • Verbal and written communication skills including listening, discussing and documenting medical needs with members, providers, internal staff/management, external vendors, and community resources.
  • PC proficiency to include Word, Excel, PowerPoint, database experience and Web based applications.
  • Current driver's license, transportation and applicable insurance.
  • Ability and willingness to travel within assigned territory.

Preferred Skills

• UM, CM or DM experience with a Managed Care Organization (MCO)
• Patient education experience.
• Bilingual - English and Spanish
• Knowledge of the health and wellness marketplace and employer trends.
• Experience in managing complex or catastrophic cases.
• Certification in Case Management, Training, Project Management or nationally recognized health care certification.
• Personal management skills - Plan and manage multiple assignments and tasks, set priorities and adapt to changing conditions and work assignments. Teamwork -ability to work well with one or more groups.
• Interpersonal effectiveness - Relate to co-workers and build relationships with others in the organization.
• Strong work values - Dependability, honesty and a positive attitude.