The Case Manager will empower members to develop the skills and confidence required to effectively manage their chronic condition(s). Case manager will outreach to members telephonically and provide education, assist with setting personalized goals and encourage development of an action plan to achieve these goals. This oversight will allow the member to effectively self-manage their chronic condition(s) and make informed health decisions
1. Perform telephonic outreach to engage members in Wellness Program who were recently hospitalized or identified as having a chronic condition
2. Provide telephonic coaching, counseling, consultation and referral services to members managing chronic health conditions
3. Promotes wellness by coaching, motivating and educating members to attain maximum mental and physical wellbeing.
4. Manage high profile City of NY Gold Card program members in conjunction with
clinical staff at Emblem Health supporting the City of NY account or other key high profile
customers for Wellspark.
5. Provide education to members regarding appropriate preventive care, and skills required to self-manage a chronic condition(s).
6. Reduce gaps in care by monitoring member compliance with current disease specific clinical guidelines
9. Connect the member with available educational and community resources
10. Responsible to provide counseling and guidance to health coaches on clinical matters and
jointly decide best care coordination, or counseling for the participant allowing for smooth
transitions between nurse and health coaches at Wellspark and Emblem Health
11. Assist with daily coverage of a phone queue for incoming member calls to Wellness Program
12. Maintains current state of the art working knowledge of his/her nursing specialty,
and related computer programs through continuing education, community resources and publications.
14. Occasional travel to New York City to represent CNY Gold HMO Wellness Program at open enrollment events throughout the year
1. Valid RN License in the State of CT, or State of NY. If not in possession of State of NY RN License, will require endorsement to practice in NY State upon hire.
2. Education: Graduate of an Associate s or diploma program in nursing; graduate of BSN program, preferred or an equivalent combination of education and experience.
3. Minimum of 3 years of clinical experience (Homecare experience a plus)
4. Strong oral and written communication skills.
5. Strong time management and organizational skills
6. Must possess substantial clinical skills and a passion for health improvement
7. Excellent interpersonal skills and the ability to work in a team environment
9. Previous system use experience in a highly automated environment and strong personal computer literacy on Windows products
11. Health insurance background preferred.
12. Bilingual Spanish or Chinese preferred.
Essential Job Functions:
1. Primarily sedentary
2. Occasional travel to New York city.
3. Flexible hours required, including up to 2-3 evenings (10am-6pm or 12pm-8pm) per week and occasional Saturday hours. Opportunity for occasional work at home after competency in performing role is established.
4. Must be able to use standard office equipment