Maryland Physicians Care · 18 hours ago
ToC Care Manager (RN) *Meritus
Baltimore,MD,US
Full-time
Onsite
Entry, Mid Level
2+ years expMaryland Physicians Care is a leading Medicaid-managed care organization in Maryland, and they are seeking a ToC Care Manager (RN) to oversee care plans for high-risk members. The role involves collaborating with interdisciplinary teams, managing care processes, and ensuring quality and continuity of care for members with special needs.
Insurance
Responsibilities
Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members
Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs
Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management
Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members
Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs
Utilizes clinical judgment to discharge members from care management according to plan policies and procedures
Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems
Collects, evaluates, and reports clinical, functional and program activity as applicable
Identify cases to assess for impact of care management services, may assist in the collection of data
Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning
Coordinates and communicates with community support and social service systems for members
Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration
Assists with the development of policies and procedures related to care management
Communicate effectively with supervisor/manager regarding departmental issues, member issues, program status, compliance issues, etc
Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures
Demonstrates an understanding of the functions of other departments, communicates with other departments appropriately and maintains positive working relationships
Identifies and reports gaps in the service delivery system
Qualification
Required
Registered Nurse with current state license
2+ years of clinical nursing experience in acute care or community setting
Demonstrated experience helping members using community agencies
2 years of care management experience
The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary
Ability to conduct presentations and training before small and large groups
Knowledge of the Americans with Disabilities Act of 1990
Demonstrated skill in written and oral communication to include presentations and training before small and large groups
Preferred
Knowledge of Managed Care Programs
BSN
CCM
Benefits
Medical, dental, and vision plans
100% employer Term Life Insurance
Short and Long-Term Disability
401k Employer Match up to 4%
20 days of PTO
Tuition assistance/professional development plans
Company
Maryland Physicians Care
Maryland Physicians Care (MPC) is a local managed care organization owned by Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Jason Rottman
President and CEO
Chuck Buseck
Chief Operating Officer
Company data provided by crunchbase