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JOB SUMMARY

Under the supervision of the Senior Director of Chronic Care Management Division, the Chronic Care Management RN will be responsible for the supervision of identified members in the Remote Monitoring Program. He/she will provide implementation of Remote Monitoring and compliance with health plan, CMS, DHCS, NCQA regulations. The goal of the CCMCM is to ensure members identified in these programs are compliant with treatment recommendations, equipment is in good working condition, alerts have proper interventions timely and communication with member’s healthcare providers are up to date. In addition, the CCMCM will be responsible for monthly reports that include total number of memberships in the program, compliance issues, re-admissions, ED visits, number of interventions processed and all outcome measurable data. He/she will recommend and develop care plans for members with high alerts and refer those members to Ambulatory Case Managers to track the 30-day progress. Should a participating member require a home visit (for equipment management or instruction) the CCMCM will arrange for a home visit utilizing approved staff. This position reports to the Senior Director of Chronic Care Management. The position is responsible for participating in health plan audits ensuring compliance with Medical Management policies and procedures and ensure compliance with all regulatory requirements. He/She will update policies and procedures to describe the program and processes and will work with Information Technology to development outcome metrics. In addition, monthly meetings with Program Medical Director, Director of Case Management, Chief Medical Officer, Chief Operations Officer and Program Specialist to discuss program metrics will be established. All other duties assigned that benefit the department and/or program. This position has no managerial responsibilities.

QUALIFICATIONS

· Minimum five (5) years’ experience in the healthcare management managed care environment required; including third-party contracting, negotiating, reimbursements and analysis.

· Minimum three (3) years of experience in a disease management programs.

· Preferred experience in managing analyzing and reporting data related to readmissions, disease management or special program outcomes and all activities related to outpatient management of senior populations.

SKILLS

· Must have effective communication, facilitation, interpersonal and professional diplomacy skills.

· Strong attention to detail with ability to manage multiple priorities while meeting deadlines.

· Able to Problem-solve, negotiate, and demonstrate independent decision-making.

· Strong communication skills in both oral and written form.

· Positive attitude and takes a team approach to management.

· Maintain strong skills in diplomacy, professionalism and trustworthiness.

· Familiarity with Microsoft applications, which include the ability to learn new computer systems and applications.

· Ability to manage multiple priorities and projects.

· Detail oriented with desire for producing work with 100% accuracy.

· Excellent analytical and problem-solving skills.

As an Equal opportunity employer, DBA Choice Medical Group is committed to a diverse workforce. Employment decisions regarding recruitment and selection will be made without discrimination based on race, color, religion, national origin gender, age sexual orientation, physical or mental disability, genetic information or characteristic, gender identity, and expression, veteran status, or other non-job related characteristics or other prohibited grounds specified in applicable federal, state and local laws. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans’ Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact this post for assistance.

For more information about equal employment opportunity protections, please view the ‘EEO is the Law’poster.

NOTICE: EMPLOYEE POLYGRAPH PROTECTION ACT
YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT

PAY TRANSPARENCY NONDISCRIMINATION PROVISION

Our environment respects individual differences and recognizes each employee as an integral member of our company. Our workforce reflects these values and celebrates the individuals who make up our growing team.

Choice Medical Group provides a work environment free of harassment and prohibited conduct. We promote and support individual differences and diversity of thoughts and opinion.

Job Type: Full-time

Pay: $36.00 - $50.40 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Vision insurance

Standard shift:

• Day shift

Weekly schedule:

• 5x8

Experience:

• Nursing: 1 year (Preferred)
• Complex Case Management: 1 year (Preferred)

License/Certification:

• BLS Certification (Preferred)
• RN (Preferred)

Work Location: Remote

Apply Here

About Choice Medical Group

CEO: Manmohan Nayyar
Revenue: $5 to $25 million (USD)
Size: 1 to 50 Employees
Type: Company - Private
Website: www.choicemg.com