RN Care Manager (ACO Reach) - Belong Health
King of Prussia, PA
About the Job
Hello, we're Belong.
We partner with regional payers to deliver Medicare Advantage and Special Needs Plan products.
With a dual focus on data-driven, proactive clinical intervention and unwaveringly empathetic patient experience, Belong has completely reimagined health insurance for seniors and other Medicare-eligible individuals who have been disregarded and deprioritized for far too long.
We believe that only by recognizing individuals can we make communities strong.
Belong Health. Kinder, more supportive care.
As a Registered Nurse (RN) Care Manager for Belong Health's ACO Reach program, you will be responsible for applying care management principles when engaging beneficiaries, providers, to coordinate beneficiary care including developing and maintaining a collaborative relationship with provider practices, community-based resources, and the Belong Health team. This is a customer facing remote position that involves a significant amount of interaction via phone with clients, beneficiaries, and patients.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
- Work directly with beneficiaries, their families and/or advocates, providers, and community service organizations on an ongoing basis to coordinate care that is safe, timely, effective, efficient, equitable, and reduces barriers to care.
- Orient new members to the Belong Health ACO program and educate the beneficiary and/or caregivers to care management services.
- Advocate, empower, inform, and educate beneficiaries on self-management techniques.
- Conduct assessments to identify barriers and opportunities for intervention.
- Develop and implement the individual care plan (ICP).
- Lead interdisciplinary care team meetings.
- Collaborate with provider, social workers, discharge planners, and community-based service providers to coordinate care and achieve care plan goals.
- Document all care management activities in the appropriate system in accordance with internal and established documentation procedures.
- Review electronic health records to gather information about beneficiary medical, behavioral health, and social conditions.
- Promote a culture of accountability and performance to meet and exceed personal service vision goals and ensure timely and satisfactory resolution of highly complex, specialized, and non-routine customer issues.
REQUIRED PROFESSIONAL EXPERIENCE AND QUALIFICATIONS
- Two or more years of experience in a health plan, health care organization (i.e. hospital or clinic), or Accountable Care Organization (ACO).
- Proficient in navigating multiple systems; strong demonstrated PC skills using Microsoft applications.
- Experience in participating in cross departmental projects and policy and procedure changes, including coordination of activities and initiatives across departments.
- Excellent customer service, trend identification, and analytical skills, with a demonstrated ability to problem solve effectively and efficiently; strong organizational and follow-through skills.
- Commitment to high ethical standards in all work; protects the privacy of member and company data and exercises discretion in handling confidential member information.
- Excellent oral and written communication skills, including presentation skills.
- Strong active listening, issue assessment and problem-solving skills.
- Self-directed and able to work autonomously and as part of a collaborative team
- Comfortable in a fast-paced environment with multiple cases; able to organize and prioritize work.
- Excellent time management skills; organized and able to prioritize
PREFERRED PROFESSIONAL EXPERIENCE AND QUALIFICATIONS
- Previous care management experience.
- Knowledge of community services and resources.
- Bi-lingual Spanish speaking.
EDUCATION AND TRAINING
- A Bachelor of Science in Nursing (BSN) or equivalent is required.
LICENSE AND CERTIFICATION
- Active, unrestricted compact nursing license is required.
- Willingness to pursue additional nursing state licensure as needed to meet business needs
WORK ENVIRONMENT
The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet. Most of the work is performed on a computer and in a sedentary environment.
TRAVEL
This role may require some travel based on business needs, including but not limited to traveling to quarterly or semi-annual onsite meet ups.
PAY TRANSPARENCY
$90,000-$105,000
Belong Health is an equal opportunity employer and encourages all applicants from every background and life experience to apply.
Our organization participates in E-Verify to confirm the eligibility of employees to work in the United States. (Nuestra organización participa en E-Verify para confirmar la elegibilidad de los empleados para trabajar en los Estados Unidos.)
