Care Management Relationship Manager
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POST DATE 9/13/2016
END DATE 11/10/2016
Tufts Health Plan
JOB DESCRIPTIONThe Tufts Health Plan Care Management Liaison works collaboratively with the Fund's Patient Advocate to encourage participation and engagement in care management programs.
The Care Management Liaison works in a co-located setting at Tufts Health Plan and at The Fund. This position provides support to the Fund, combining strong clinical knowledge, interpersonal skills, cultural sensitivity, and critical thinking to facilitate enrollment in care management programs for the high risk member population serviced by Tufts Health Plan.
* Collaborate with the Fund Patient Advocate for coordination of outreach, services, education and community resources as appropriate for Fund members.
* Provide the Fund Patient Advocate with information on members identified for care management programs to the Fund Patient Advocate
* Assess barriers to participation in care management programs and recommend strategies to address.
* Facilitate regularly scheduled meetings with stakeholders to discuss review goals, monitor progress and identify strategies to achieve goals.
* Assists with referrals to appropriate program(s) or resources
* Day of Admission report to assist with keeping members within the select network
* Identifying and following up with members that do not have assigned PCPs
* Identifying and following up with members that have a recent ER visit that was not admitted
* Working with Alere vendor liaison to assist with the process for device placement
* Identify and work with Client Health
* Representatives/interpreters to choose /establish relationship with PCP
* Identify members for Client OB discharge call program and THP High Risk OB CM programs
* Network with community partners to promote initiatives that will serve client and member needs
* Interpret monthly costs to identify cost drives and recommend initiatives to mitigate costs
* Demonstrates the following abilities to support engagement: Ability to access and interpret member benefit plan information and knowledge of funding resources, support services, clinical standards and outcome measures.
* Must be able to accommodate flexible work hours to meet client needs.
* Maintains compliance with Tufts Health Plan Corporate Communication Policy, standards for managing voice mail and will be available by phone during normal business to both internal and external customers. Maintains compliance with Corporate Compliance Policies and periodic trainings.
EDUCATION: (Minimum education & certifications required)
Registered Nurse with current unrestricted state license required. Bachelor's in Nursing preferred. National Certification in Case Management is highly desirable.
EXPERIENCE: (Years of experience)
Minimum of five years of clinical nursing experience; Experience in medical case management highly desirable;
Proficiency in a second language is highly desirable.
Experience in presenting to diverse audiences.
SKILL REQUIREMENTS: (Include interpersonal skills)
* Address multiple complex issues throughout the workday in a flexible professional manner.
* Knowledge and experience in effective engagement strategies across populations
* Demonstrate strong clinical analytic and critical thinking abilities
* Excel in positive relationship building.
* Effective listening skills, written and verbal communication abilities
* Skilled negotiator
* Computer literate; proficient in Microsoft suite
* Ability to perform job functions with autonomy
* Ability to collaborate effectively and influence others
* Must have commitment to excellence in customer service
Maintains compliance with Tufts Health Plan Corporate Communication Policy, standards for managing voice mail and will be available by phone during normal business to both internal and external customers. Maintains compliance with Corporate Compliance Policies and periodic trainings.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)
* Fast paced office environment handling multiple demands.
* Position has opportunity for remote work as defined by the Manager or Director, Commercial Care Management
* Must be able to exercise appropriate judgment when necessary.
* Must be able to work and communicate with customers in a telephonic office as well as in person meetings.
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled