Case Manager, Health Management





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

Key Accountabilities:

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

7. Empower members to become an active participant in their own health outcomes by utilizing motivational interviewing and behavior change techniques

8. Promotion of healthy lifestyle to aid in lowering member health risks and preventing illness.

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.

13. Manage a flexible work schedule to meet the needs of the member and optimize telephonic outreach rates.

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

8. Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.)

9. Previous system use experience in a highly automated environment and strong personal computer literacy on Windows products

10. Previous coaching experience or Certification as a Chronic Care Professional (CCP) is preferred

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

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