Company: Hines & Associates Inc
Posted on: February 9, 2024
Description:About usHines is a nationwide, independent leader in
personalized managed health care, focused on what's important to
you-comprehensive services with the program excellence and cost
containment that you demand. Hines & Associates, Inc.'s reputation
as an industry leader is founded on over three decades of
innovative and professional health care excellence. What we
- Competitive salary and benefits, including medical, dental,
vision, long-term care, short-term disability, long-term
disability, and company paid life insurance.
- 401k plan with company match, fully vested after 1 year.
- Paid holidays and time off.
- Work-life balance.
- No weekends or holidays!
- Hybrid setting; up to 2 days per week remote. OverviewOur
Chronic Condition Manager role allows you to utilize your clinical
nursing experience to develop a plan for meeting health care needs
of the patient, while continuing to professionally grow in health
care knowledge and perspective. Be the patient advocate you desire
to be! In this key role, the ideal candidate will be responsible
for utilizing medical knowledge to assess patient and provide
individualized coaching for the purpose of developing a plan for
meeting the health care needs and patient's goals of
self-management of chronic medical conditions. The Chronic
Condition Manager is accountable for telephonic assessment,
planning, implementation, coordination, education, monitoring,
evaluation and outcomes measurement. The Chronic Condition Manager
is a patient advocate, promotes safety and maintains privacy and
confidentiality in accordance with policies and procedures. Duties
- Identify problems while assessing the patient's medical and
psychosocial status, including environmental and cultural
- Determine economically responsible options available to meet
the patient's medical and care needs,
- Understand policy/benefit plans and systems.
- Collaborate with physician(s), provider(s), and patient/family
and payers to facilitate quality, timely and efficient medical care
across the healthcare continuum.
- Implement disease management plan by coordinating resources,
including community resources, healthcare providers and significant
- Evaluate the disease management plan and its effects on the
patient and make modifications as necessary.
- Improve the health outcomes and quality of life with reduced
complications and costs for persons with chronic health
- Promote patient self-management of chronic health conditions
through individual assessment, education and use of motivational
- Utilizes clinical practice guidelines and promotes best care
for people with chronic medical conditions
- Demonstrate ability to communicate effectively with TPAs,
insurers, physicians, patient/family, and other healthcare
providers, including ability to negotiate with assertiveness.
- Effectively communicate the disease case manager's impressions
of methods available to provide for the medical needs of the
individual patient or the need to refer to a higher level for
review of questionable plans of treatment.
- Provide written documentation concerning the information
obtained regarding the patient's status, treatment plan and disease
- Interfaces with UM, CM and peer review, and other programs, as
indicated on active cases.
- Communicate knowledge of policy and procedure, standards of
practice, and their revision; Participates in annual HIPAA, ethics,
cultural, and URAC standards training.
- Provide good customer relations by promoting good will and
understanding between claimant, payer, providers and professional
staff at all times.
- Acts as an advocate, maintains privacy, confidentiality,
promotes safety, and is compliant with policies and procedures,
URAC standards and other regulatory standards.
- Responsible for and retains accountability for the disease
management plan and process when using assistance of support staff;
provides input on the support staff to their supervisor.
- Special projects as assigned by
- Registered nurse with current unrestricted license to practice
in the state or in a state that has licensure reciprocation with
the state of the office location that employee is working in.
Registered Dietitian practices under current unrestricted
registration as dictated by the Commission on Dietetic
- Successful completion of disease management orientation
- Minimum of 2 years full time equivalent of direct clinical care
to the consumer.
- Excellent communication skills.
- Basic typing/computer knowledge with minimum keyboarding speed
of 35 WPM.
- Previous disease management or case management experience
helpful but not required.
- Obtaining certification in CCM or CHC is encouraged.Physical
- No significant physical exertion required. Hines welcomes
diversity and as an equal opportunity employer, all qualified
applicants will be considered regardless of race, religion, color,
national origin, sex, age, sexual orientation, gender identity,
disability or protected veteran status.
Keywords: Hines & Associates Inc, Dubuque , Registered Nurse, Healthcare , Dubuque, Iowa
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