Alignment Health
Alignment Health
Alignment Health — Medicare бағдарламасына қатысушыларға, әсіресе қарт адамдарға, созылмалы аурулармен өмір сүретіндерге және әлсіз, ерекше күтімді қажет ететін жандарға медициналық көмекті жақсартуға бағытталған медициналық сақтандыру компаниясы. 2013 жылы құрылған компания жекелендірілген күтім үлгісін технологиямен және сенімді жергілікті қызмет көрсетушілермен қолдауды үйлестіретін тәулік бойы жұмыс істейтін кеңес беру тобымен ұштастырады. Оның қызметі денсаулық сақтау қызметтерін көрсету мен сақтандыру салаларын қамтиды және мүшелері үшін көмекті қолжетімді, жедел әрі шығынды ескеретін етуге бағытталған. Alignment Health Medicare қауымдастықтарының қажеттіліктеріне қызмет көрсететін өсіп келе жатқан денсаулық сақтау ұйымының әртүрлі бағыттарына қызметкерлер қабылдайды.

Remote Bilingual Spanish RN Case Manager, Transition of Care

Coordinate complex and chronic care for Alignment Health members through remote case management. Develop care plans, arrange authorizations and referrals, and collaborate with providers by phone.

Сипаттама

  • Connect members with services that address their health needs.
  • Assess members and manage their cases according to established criteria.
  • Carry out care plans by arranging authorizations and referrals within members’ benefits or through special arrangements.
  • Use independent judgment to assess authorization requests and coordinate internal and external resources.
  • Track care plan effectiveness and adjust plans when needed.
  • Coordinate treatment plans with primary care physicians, hospitalists, nurse practitioners, and specialists.
  • Negotiate reimbursement rates when applicable.
  • Help resolve provider, claims, and service issues.
  • Evaluate intervention results to measure case management outcomes.
  • Contribute feedback on utilization and care management policies and procedures.
  • Discuss available care options with patients and families to help them choose suitable and preferred next steps.
  • Perform most duties by phone.

Талаптар

  • At least five years of clinical case management experience, or an equivalent combination of education and experience.
  • Associate or bachelor’s degree in nursing.
  • Current, unrestricted RN license in the state where you are applying.
  • Ability to communicate positively, professionally, and effectively; provide leadership; teach; and collaborate.
  • Strong written and verbal communication skills, with the ability to build constructive relationships with diverse members, managers, employees, and vendors.
  • Problem-solving, organization, and time management skills, and the ability to work in a fast-paced setting.
  • Ability to meet essential physical requirements, including standing, walking, sitting, using hands and fingers, reaching, talking, hearing, lifting and moving up to 10 pounds, and performing close-vision tasks and adjusting focus.

Ұқсас жұмыс орындары

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