Care Manager, Bellevue, WA
Healthcare Management Administrators (HMA) is the leading third party administrator of health care benefit management in the Pacific NW. Based in Bellevue, WA, HMA’s guiding principles include an active investment in the success of all team members, valuing a work life balance in the setting of an ever-changing health care environment. We are looking for an agile, experienced RN with expert clinical skills, a growth mindset and a driving desire for excellence to join our Care Management team.
Care Management is a medical management model incorporating both Case Management and Utilization Management methodologies. Care Managers work with members directly as well as providers, hospital staff, vendor partners and clients. With an evolving healthcare industry, there is a higher demand for integration of services geared towards promoting health and controlling costs. Care Management generates a positive return-on-investment through the promotion of quality clinical outcomes and cost-avoidance strategies based on the coordination of healthcare services.
Responsibilities and Accountabilities
- Manage an assigned book of business to ensure member engagement with the correct care at the correct time. This includes case reviews, concurrent management, and discharge management for members moving through a course of medical care or treatment.
- Collaboration with providers, facilities, outpatient services and community resources to ensure maximum quality health outcomes for the member and benefit management for our clients.
- Provide health coaching and education for members related to their health care needs.
- Identify and initiate quality care improvement measures and cost containment processes to ensure value-based care across the continuum.
- Strong verbal and written communication skills with a willingness to engage with all involved parties including clients, account managers, vendors and partners.
- Engagement in accurate data analysis and outcomes-based documentation to support client reporting.
- RN credential, BSN preferred
- 3+ years of clinical nursing in an acute care inpatient setting, emergency department, intensive care or behavioral health care setting
- Strong problem solving, decision making and critical thinking skills
- Extensive knowledge of Case Management and Utilization Review process
- Behavioral health provider or payer experience preferred
- Solid experience using Microsoft Office and Microsoft applications
- Ability to be self-motivated and self-directed
- Ability to manage self and others in a deadline oriented production environment
Please apply online at www.accesshma.com