StLouisRecruiter Since 2001
the smart solution for St. Louis jobs

Field Care Manager

Company: Wellcare Health Plans
Location: Saint Louis
Posted on: September 15, 2019

Job Description:

Department: Missouri Care ManagementReports to: Manager, Care ManagementLocation: St. Louis, MO Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.Essential Functions: Evaluates members for case management services and determines appropriate level of care coordination/ management services for member. Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services. Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description. Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities. Interacts continuously 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. Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers). Act as liaison and member advocate between the member/family, physician and facilities/agencies. Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines. Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues. Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities. Meets with clients in their homes, work-sites, physician's or hospital to provide management of services. Adapts to changes in policies, procedures, new techniques and additional responsibilities. Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds. Perform other duties as assigned. Additional Responsibilities: Travel to inpatient bedside, member's home, provider's office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. May require climbing multiple flights of stairs to a member's home, provider's office, etc.Candidate Education: Required A Bachelor's Degree in Health Services or Nursing Required or equivalent work experience Candidate Experience: Required 2 years of experience in clinical acute care, post acute care, home health care, or maternity Preferred 1 year of experience in current case management Preferred Other Managed care experience Preferred Other Prior utilization management experience preferred in some geographic regions Preferred Other Experience in care of the elderly is required in some geographic regions Preferred Other Experience in home health, physicians office or public health Required Other Associates supporting Florida's Children's Medical Services (CMS) must have a minimum of two (2) years' experience in Pediatrics. Required Other Work experience requirements may be waived for associates engaged in Florida's CMS contract that worked in a similar capacity for Florida's Department of Health in 2018. Candidate Skills: Intermediate Ability to multi-task Intermediate Ability to work independently Intermediate Demonstrated time management and priority setting skills Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Ability to create, review and interpret treatment plans Intermediate Ability to implement process improvements Intermediate Ability to effectively present information and respond to questions from families, members, and providers Intermediate Other Ability to understands the business and financial aspect of case mgmt in a managed care setting Intermediate Knowledge of healthcare delivery Intermediate Knowledge of community, state and federal laws and resources Intermediate Demonstrated written communication skills Intermediate Demonstrated customer service skills Licenses and Certifications:A license in one of the following is required: Required Licensed Registered Nurse (RN) Required Other Maintain required contact hours to fulfill regulatory requirements Preferred Certified Case Manager (CCM) Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Excel Required Intermediate Microsoft Outlook Required Intermediate Healthcare Management Systems (Generic) Languages:Required Other In the state of NY, associates may be required to be proficient in one of two buckets of languages. Bucket one consists of the below:Required BengaliRequired Other Bucket two consists of:Required Other CantoneseRequired Other FujianeseAbout usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, St. Louis , Field Care Manager, Executive , Saint Louis, Missouri

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Registered Nurse Manager/Resident Care Director - St. Louis
Description: Overview br MAKE A DIFFERENCE EVERY DAY IN A UNIQUELY SUPPORTIVE COMMUNITY AND IGNITE YOUR FULL POTENTIAL.--We champion quality of life for all seniors - and quality careers for our team members. --A (more...)
Company: Sunrise Senior Living
Location: Saint Louis
Posted on: 09/21/2019

Hospitalist-Director (Physician #)
Description: Seeking a Director of Hospitalists to manage and lead a team of 14 Hospitalists. University affiliated with a
Company: The Toberson Group
Location: Saint Louis
Posted on: 09/21/2019

Assistant Nurse Manager Stroke Unit
Description: A rewarding position is now available for an Assistant Nurse Manager over the Neurology and ENT units with a well-known acute care hospital. This is a great opportunity to join a larger health system (more...)
Company: Nurse Management
Location: Chesterfield
Posted on: 09/21/2019


Patient Access Services Manager
Description: Title: Patient Access Services Manager Location: Springfield, IL Type/Shift: Full Time, 8:00am-4:30pm Overview: Directs and coordinates the activities of patient registration within MMC, including offsite (more...)
Company: Memorial Health System
Location: Springfield
Posted on: 09/22/2019

Acute Care Business Manager, Denver
Description: JOB DESCRIPTION br br Hospital based sales position focused on launching and selling novel compounds in the hospital setting. Position requires successful navigation of the hospital formulary process (more...)
Company: Mallinckrodt Pharmaceuticals
Location: Saint Louis
Posted on: 09/22/2019

Branch Manager (MLO) - Traditional Branch
Description: Position Overview br br At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. (more...)
Company: PNC Financial Services Group
Location: Springfield
Posted on: 09/21/2019

Project Management Specialist
Description: The Project Management Specialist Smart Meter Project is responsible for assisting the SMP Deployment Team in meeting compliance with administrative and records management procedures as it relates to (more...)
Company: Ameren Services Company
Location: Saint Louis
Posted on: 09/22/2019

Assistant Nurse Manager, Neuro Medicine
Description: Company ul li Ranked as one of the nation's top hospitals by U.S. News World Report li World-renowned surgeons and anesthesiologists li
Company: Odell Medical Search
Location: Saint Louis
Posted on: 09/21/2019

Sr. Project Manager, New Solutions
Description: POSITION SUMMARY br br Provide project management for strategic and tactical projects. Key initial projects will include management of Laser Messaging, and development of key clinical products that (more...)
Company: Express Scripts
Location: Saint Louis
Posted on: 09/22/2019

AAA - Membership Sales Manager
Description: ACE Group Membership Sales is seeking a career-minded individual for our Membership Sales Manager opportunity in the Missouri area. This position is responsible for achieving performance objectives as (more...)
Company: Auto Club of Missouri
Location: Saint Louis
Posted on: 09/21/2019

Log In or Create An Account

Get the latest Missouri jobs by following @recnetMO on Twitter!

St. Louis RSS job feeds