Position Description:

Responsibilities:
• Responsible for carrying out telephonic Case Management activities on all Medicaid members in the program with the highest acuity level
• Activities include assessment, planning, implementing, coordinating, monitoring and evaluating the services and resources necessary to respond to an individual member's health needs.
• Activities and interventions performed across case management practice and processes maintain member's privacy and confidentiality by adhering to HIPAA regulations
• In addition, responsibilities will include providing education by interacting with members/family, practitioners, social workers and medical office staff to obtain established goals and outcomes for members
• Performing Care Plan development and follow-up in accordance with established goals
• Monitoring for quality of care and outcome improvement in accordance with clinical indicators as per contractual obligations
• Communicating with providers in the community regarding the consumer's treatment needs and developing appropriate care plans for specialized needs of members; and
• Others duties as assigned

Educational Requirements:
• Registered Nurse with active Georgia license
• CCM Preferred
• Ability to sit for CCM within 15 months of hire

Qualifications:
• Minimum of 2-3 years experience in related public sector medical services including experience with quality improvement, medical record reviews, disease management and/or primary care case management;
• Two years of current clinical nursing experience and must possess clinical experience in an area such as medical, surgical, critical care, home health or skilled nursing.
• One to two years of experience in case management, discharge planning, and/or utilization review), and/ or quality improvement
• Experience with chronic illness and disease states targeted by DCH strongly preferred;
• Strong verbal and written communication skills
• Experience with clinical care computer systems, data entry and call center environment preferred;
• Customer service focus; and
• Ability to utilize critical thinking and problem solve in a non-threatening manner




External:
Responsibilities:
• Responsible for carrying out telephonic Case Management activities on all Medicaid members in the program with the highest acuity level
• Activities include assessment, planning, implementing, coordinating, monitoring and evaluating the services and resources necessary to respond to an individual member's health needs.
• Activities and interventions performed across case management practice and processes maintain member's privacy and confidentiality by adhering to HIPAA regulations
• In addition, responsibilities will include providing education by interacting with members/family, practitioners, social workers and medical office staff to obtain established goals and outcomes for members
• Performing Care Plan development and follow-up in accordance with established goals
• Monitoring for quality of care and outcome improvement in accordance with clinical indicators as per contractual obligations
• Communicating with providers in the community regarding the consumer's treatment needs and developing appropriate care plans for specialized needs of members; and
• Others duties as assigned

Educational Requirements:
• Registered Nurse with active Georgia license
• CCM Preferred
• Ability to sit for CCM within 15 months of hire

Qualifications:
• Minimum of 2-3 years experience in related public sector medical services including experience with quality improvement, medical record reviews, disease management and/or primary care case management;
• Two years of current clinical nursing experience and must possess clinical experience in an area such as medical, surgical, critical care, home health or skilled nursing.
• One to two years of experience in case management, discharge planning, and/or utilization review), and/ or quality improvement
• Experience with chronic illness and disease states targeted by DCH strongly preferred;
• Strong verbal and written communication skills
• Experience with clinical care computer systems, data entry and call center environment preferred;
• Customer service focus; and
• Ability to utilize critical thinking and problem solve in a non-threatening manner