Careers

Employee Health Plan Case Management

Rapid City, SD Full time 21_1060

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Job Category

Patient Services

Department

CS Managed Care

Scheduled Weekly Hours

40

Shift

Employee Type

Regular

Job Summary

The Employee Plan Case Management Support role will enhance the quality of patient management, maximize satisfaction and promote cost effectiveness for all system Value Based Programs. The Case Manager Support role coordinating care that is safe, timely, effective, efficient, equitable and patient centered.

Job Description

Essential Functions: 

  • Handle case assignments, draft service plans, review case progress, and determine case closure.
  • Facilitate multiple care aspects including but not limited to: Pulling care gap reporting from payer client platforms, distribution and management of care gap/care plan reports to Attributed primary care clinics.
  • Develop effective working relationships and cooperate with medical teams throughout the case management process
  • Third party administrator, Consultant and network resources management and oversight.
  • Develop, maintain and manage reporting for non- claims based quality measures.
  • Monitoring and managing the PMPM cost of care, and patient risk scores.
  • Monitoring, recommending and training on Pharmacy and Medical Care alternatives.
  • Transitions of care management for Plan members who were referred out of the area for care.
  • Maintenance, management and recommendations for prior authorization lists.
  • Medical Director Meetings with TPA Medical Director on care plans, care management. opportunities and risk evaluation for risk score jumpers.
  • All additional duties as assigned.

Additional Requirements

Required:

Education - Associates degree in Nursing

Certification - Registered Nurse (RN) - South Dakota Board of Nursing

Preferred:

Education - Bachelors in Nursing

Certification - Certified Case Manager (CCM) - Commission for Case Manager Certification

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

15 Corporate Services Division

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Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

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