Nurse Case Management Senior Analyst

  • Location

    Wyndham Hills, United States

  • Sector:

    Other Area(s)

  • Job type:


  • Contact:

    Leric Arcigal

  • Job ref:


  • Published:

    over 1 year ago

  • Expiry date:


The Temp staff will be responsible for working with our Special Needs Plan- (medicare/medicaid members and those on our diabetic plan- which comprise 46% of our current membership) and completing the model of care requirements around Health Risk Assessments (HRA), High Risk Care Planning and Interdisciplinary Care Team meetings. The target lists typically consist of ~ 300 members each week; there is also a back log of 604 customers that need outreach and documentation on top of the normal weekly volume.

The Temp staff will need to make outreach to the member following our work aides and complete a HRA with the customer, create the appropriate Care Plan (CP) using Note Cube (template), constructing letters and documenting in CCMS (online documentation tool). Time for completion of the entire process from beginning to end can take anywhere from 45 minutes to an hour. Anticipated volume would be 8-10 per day. The addition of the Temp staff would allow the Community Based Case Managers (CBCMs) to get back in the field and support our membership by providing the CTC (Care Transitions Coaching) CM program which they are targeted to enroll 60% or our membership in but have not been able to do so since the SNP work has taken priority. The current staff have been pulled out of the field, starting February 2017 approximately 90-100% of the time to work the SNP lists that we have been receiving minimally weekly

Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient settings. Responsible for educating and motivating Customers to participate in wellness programs. Support health promotion and disease prevention and care management services. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Manages own caseload and coordinates all assigned cases.

The Health Risk Assessments are physical health risk assessments for a Managed Medicare Population completed by the customer with case management support.

Ideal candidate would have previous case management experience with the Medicare/Medicaid population specifically focusing on Special Needs Plan Model of Care documentation requirements, care coordination working with hospital settings and Primary Care Physician offices.

Knowledge of community resources is also helpful.