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Nurse Case Management Senior Analyst
Ref No.: 20-02816
Location: Philadelphia, Pennsylvania
Title: Nurse Case Management Senior Analyst
Duration: 07/06/2020 through  12/31/2020 with opportunity for conversion! 
Schedule: Monday - Friday 8:00am - 5:00pm. Thispositions will primarily be WFH, however we need the flexibility of the candidates going into the office if needed. While we do not anticipate that need to be with any type of regularity-if we identify a reason for this they would need to be able to do so.
Location: this position is temporarily work from home due to COVID 19. Candidates must be local to the Philadelphia, PA location

Job Description: 
The Nurse Case Managemnt Senior Analyst will be responsible for performing complex case management with our dual eligible (medicare/medicaid) members and those on our diabetic plan- which comprise 46% of our current membership and completing the model of care requirements around Health Risk Assessments (HRA), High Risk Care Planning and Interdisciplinary Care Team meetings. The Health Risk Assessments are physical health risk assessments for a Managed Medicare Population completed by the customer with case management support. The ideal candidate would have previous case management experience with the Medicare/Medicaid population specifically focusing on Special Needs Plan Model of Care documentation requirements, care coordination working with hospital settings and Primary Care Physician offices.
  • Make outreach to the member following our work aides and complete a HRA with the customer, create the appropriate Care Plan (CP) using Note Cube (template), constructing letters and documenting in CCMS (online documentation tool). Time for completion of the entire process from beginning to end can take anywhere from 45 minutes to an hour. Anticipated volume would be 8-10 per week.
  • Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient settings.
  • Responsible for educating and motivating Customers to participate in wellness programs.
  • Support health promotion and disease prevention and care management services.
  • Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
  • Manages own caseload and coordinates all assigned cases.
  • Excellent verbal, written communication and interpersonal skills
  • Ability to learn new processes and systems quickly
  • Strong time management and organization skills
  • Ability to prioritize the work
  • Strong research, analytical and problem solving skills
  • Ability to work independently
  • Knowledge of managed care preferred
  • Effective coaching/education skills
  • Ability to work in rapidly changing environment
  • Flexibility
  • Requires two to four years clinical practice experience or certification in case management with managed care and SNP population experience at professional level.
  • Must have active Pennsylvania License (CANNOT CONSIDER LPNs)
  • Additional MD/DC/NJ license a plus
  • Experience: Senior population Chronic conditions; Ability to work with people with significant educational and or socioeconomic barriers impacting their health Education