As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

JOB SUMMARY

*Must reside in Rhode Island

The Case Management Assessment Specialist, under the direction of the Manager, assesses select member populations, identifies health and psychosocial issues, and queues the plan of care to the member and provider to ensure maximized health of the member.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Identifies issues relating to members' physical and mental wellbeing that affects health status and works in collaboration with both the member and provider to determine appropriate care for case management services.
• In collaboration with the member and PCP completes a Comprehensive Functional Needs Assessment (CFNA) and develops an Integrated Plan of Care (ICP) assessing short-term and long-term needs.
• Interacts with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
• Maintains and documents initial Comprehensive Functional Needs Assessment (CFNA); designs Integrated Plan of Care (ICP) that is attainable and in the appropriate business application program.
• Schedules or facilitates scheduling member appointments and follow-up services; requests consultation and diagnostic reports from network specialists; contacts members to remind them about upcoming appointments and/or missed appointments.
• Maintains and promotes confidentiality of patient information and adheres to all HIPAA regulations
• Maintains case volume by monitoring case status and task deadlines in the medical management platform.
• Outreaches members to schedule appointments and to complete the Comprehensive Functional Needs Assessment.
• Other duties as assigned.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Experience in Case Management or other managed care environment.
• Knowledge of disease specific states, clinical and community resources.
• Strong critical thinking and problem solving skills.
• Ability to network, advocate, communicate assertively with all customers.
• Work involving high volume and strict timeframes.
• Excellent communication skills.
• Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus.
• Ability to work in fast-paced environment.
• Works well independently as well as part of a team.
• Strong commitment to help others.
• Computer literate; must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Minimum Education: Registered Nurse
• Registered Nurse Licensure: Licensure must be current and unrestricted in state of residence
• Preferred Education: Bachelors of Science in Nursing
• Minimum Experience:
  • 2+ years of experience in a clinical acute care position, preferably in home health, physicianâ��s office or public health
• Preferred Experience:
  • 1 to 3 years disease management, case management or formal patient education experience;
  • Certified Case Manager Certification (CCM)

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• Licensure must be current and unrestricted in state of residence

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Remote

TRAVEL

• Approximately 90% - 100% travel required for member home visit assessments

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.