Manager Ncqa Jobs Near Me

Monday to Friday 8:30 am to 5:30pm.

Researching members and reaching out to members to enroll them into Programs. Traveling to surrounding hospitals in 30 mile radius to enroll members.

Need to have strong computer skills with Excel (intermediate level) and be able to work with dual computers screens

Skills:

Multi-task, detail oriented and strong customer service

Strong written and verbal English communication skills

Training is one on one training with an experience CM and supervisor for about one to two weeks

After training is complete then the production metrics is three enrollments per day. Reviewed bi-weekly with manager.

Required Education:

Bachelor's degree in Nursing.

Required Experience:

2-4 years of bedside nursing experience and case management experience is a plus.

Required Licensure/Certification:

Active, unrestricted State Registered nursing license.

Must have valid drivers' license with good driving record and be able to drive locally.

Summary:

Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care.

Coordinates and monitors member's progress and services to ensure consistent cost effective care that complies with policy and all state and federal regulations and guidelines.

Essential Functions:

Provides case management services to members with chronic or complex conditions including: oProactively identifies members that may qualify for potential case management services. oConducts assessment of member needs by collecting in-depth information from information system, the member, member's family/caregiver, hospital staff, physicians and other providers.

Identifies, assesses and manages members per established criteria.

Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.

Performs ongoing monitoring of the plan of care to evaluate effectiveness.

Documents care plan progress in information system.

Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.

Measures the effectiveness of interventions to determine case management outcomes.

Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members.

Conducts face to face or home visits as required.

Maintains department productivity and quality measures.

Manages and completes assigned work plan objectives and projects in a timely manner.

Demonstrates dependability and reliability.

Maintains effective team member relations.

Adheres to all documentation guidelines.

Attends regular staff meetings.

Participates in Interdisciplinary Care Team (ICT) meetings.

Assists orientation and mentoring of new team members as appropriate.

Maintains professional relationships with provider community and internal and external customers.

Conducts self in a professional manner at all times.

Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.

Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.

Complies with required workplace safety standards. Knowledge/Skills/Abilities:

Demonstrated ability to communicate, problem solve, and work effectively with people.

Excellent organizational skill with the ability to manage multiple priorities.

Work independently and handle multiple projects simultaneously.

Strong analytical skills.

Knowledge of applicable state, and federal regulations.

Knowledge of ICD-9, CPT coding and HCPC.

SSI, Coordination of benefits, and Third Party Liability programs and integration.

Familiarity with NCQA standards, state/federal regulations and measurement techniques.

In depth knowledge of CCA and/or other Case Management tools.

Ability to take initiative and see tasks to completion.

Computer skills and experience with Microsoft Office Products.

Excellent verbal and written communication skills.

Ability to abide by policies.

Able to maintain regular attendance based upon agreed schedule.

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.