PHP Case Manager, Care Management, Presence Health Partners:
Presence Health

43773-en_US
Presence Health
Des Plaines Illinois
Healthcare
Description

Requisition ID: 43773

Location: Dempster Offices

Location Address:
2380 East Dempster Street, Des Plaines, IL  60016-4839 United States (US)

 

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time 
Employment Type: Regular 
Shift: Day
FLSA: E

 

PHP - CASE MANAGER

Employ advanced clinical judgment and critical thinking skills to expedite appropriate physical and behavioral healthcare and social services for members through telephonic assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to advocate effective utilization of available resources, optimal member functioning, and cost-effective outcomes.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

 

  • Through the use of clinical tools, accredited criteria and review of member specific health information/data, conducts comprehensive assessments of referred member's needs/eligibility.
  •  In collaboration with the member's care team, determines an approach to resolving member barriers to optimal health by evaluating the member's benefit plan, available internal and external resources, and developing and monitoring an established plan of care to meet the member's healthcare goals.
  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member Issues.
  • Uses advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated.  Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.

 

 

QUALIFICATIONS

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.

 

Education and/or Experience  

  • Bachelor’s degree in Nursing or as a licensed Physician’s Assistant required. 
  • Master’s degree in Nursing or health related field preferred.
  • 3-5 years nursing experience e.g. hospital, alternative or ambulatory care setting required. 
  • 3-5 years Case Management and/or Managed Care experience preferred. 
  • Crisis intervention skills preferred.                                                                          

 

Computer Skills

Basic Outlook, Word, Excel skills required.

                                                               

Certificates, Licenses, Registrations

Registered Nurse with current Illinois state license or a Physician Assistant license required.  Case Management certification preferred.

SS*

 

Business Unit: Mgmt Service Organization
Department Name: Care Management

Basic Qualifications
Requirement