Nurse Case Manager (RN)/Network Coordinator - Montgomery, AL - Sage Health

About Sage Health

We believe all seniors regardless of means deserve concierge primary care & wellness, without the concierge fees. They've earned it.

Sage Health builds enriching neighborhood health centers that are easy to access, provide or arrange for all of our patients' healthcare needs, and partner with Medicare Advantage plans that fully cover primary care. Unlike other physician practices, a Sage Health physician has a patient panel of 400 or less, and we collaborate with the best outcomes-oriented specialists and hospitals in each market. Because we are not a fee-for-service provider and manage patients within a global capitation budget provided by Medicare Advantage plans, our only concern and motivation is to keep our seniors healthy.

Sage Health is a destination for the best risk provider talent in the country who are building the new standard-bearing senior model for the United States.

All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring an accommodation to complete the application and/or interview process should contact team@sage.health.

Company Perks

Join a growing company with a community focused mission to make a difference in the lives of seniors!Medical, Dental and Vision benefits with generous employer provided contributions to offset per paycheck premium costs.3 different medical plan options to provide flexibility to meet personal needs including: 2 PPO options and a CDHP plan that includes a $500/year HSA employer matchHealthcare & Dependent Care Flexible Savings Accounts (FSAs)Access to Employee Assistance Program (EAP) for personal support and work-life benefits.Employer-paid Life Insurance, Short-term and Long-term Disability benefits. Optional voluntary life insurance is also available.A 401k retirement plan offered through Transamerica for long-term financial savings & planning.Flexible time off including: PTO, 7 paid company holidays and 2 floating holidays.Opportunities for career growth and advancement within the company.

About the role

POSITION SUMMARY

The Nurse Case Manager (RN) in Montgomery, Alabama, will hold a dual role and be responsible for implementing and reviewing care plans for Sage Health patients. The Nurse Case Manager also collaborates with doctors and other medical professionals to give their assigned patients the comprehensive coordinated concierge care they need. This includes advocating for their patients, coordinating care, and providing other healthcare services and education. Additionally, the Nurse Case Manager will coordinate with the Market Network Coordinator in identifying, establishing, and maintaining relationships with value-based, high-quality providers, i.e., hospitals, specialists, home health care agencies, etc., to build Sage Health ‘s specialty network based upon our contracted health plan network.

What you"ll do

PRIMARY RESPONSIBILITIES:

Ensure patient information remains secure and confidential. Maintains a safe, secure, and healthy work environment by following Sage Health policy and procedures and complying with legal regulations. Create and manage the plan of care for patients with severe or chronic conditions such as diabetes, heart disease, chronic heart failure, and cancer etc.Advocate for personalized treatment options that address a patient's unique care needs.Schedule patients' hospital post-discharge appointments within 72 hours (3 days) post-discharge and follow up to ensure they attended.Communicate about a patient's health condition with the patient and their family.In collaboration with the patient"s primary care physicians, offer education and guidance for navigating complex medical decisions.Serve as a liaison between patients and their insurance providers to promote quality, cost-effective care with the best patient outcomes.Verifies daily Sage Health patient hospital census and planned discharges.In collaboration with the Chief Medical Officer or designee, identifies and provides appropriate resources and information to assist patients and their family members related to their diagnosis.Holds regular cadence of meetings, and communications with the following: clinical support staff, physician, and operations leadership.Assist primary care physicians in executing virtual appointments in patients" home.Ensures the overall quality of healthcare for each patient.Ensures patient electronic health records are updated with the most recent medical treatments Assist primary care physicians in executing virtual appointments in patients" home.Maintains a state of readiness for health plan audits, local, state, and federal inspections.Responsible for staying up to date and knowledgeable of all nursing regulations supporting the clinical staff.Build productive relationships within all departments in the Health Plan i.e. Provider Relations, Network, Hospital Service, Contracting, HEDIS/Quality, etc.Partners with the Market Network Manager to establish a value-based, high-quality network of providers, i.e., specialists, hospitals, DME, Home Health Care, etc., on the contracted Health Plans network.Influence Health Plans to add specialists to their network based on cost-effectiveness and quality.Perform other duties as assigned

Qualifications

REQUIRED QUALIFICATIONS:

B.S. Degree in NursingValid and active Registered Nurse license in the state of employment.Certification in Basic Life Support2-3 years" experience working in an inpatient, outpatient I.e., Home Health, Hospice, or health plan case management.Medicare Advantage experience i.e. Medicare HMO, D-SNPKnowledgeable of reimbursement methodologies: hospital, DME, and outpatient settings.Knowledge of health care issues and a variety of facilities, hospitals, or physician offices procedures, concepts, and practices.Strong knowledge of clinical assessment skills and experience with chronic disease managementExperienced working in medically underserved/culturally diverse communitiesExcellent interpersonal, written, and verbal communication skillsMust be organized and attentive to detail. Ability to manage competing priorities.Ability to work in a fast-paced environmentResourcefulness in problem solvingAble to take and follow through with assigned tasks and accountability.Valid driver"s license, car insurance, and access to an automobileMust be able to travel between multiple healthcare facilities, i.e., centers, hospitals, skilled nursing facilities, and patient homes.Strong knowledge of clinical assessment skills and experience with chronic disease managementExperience working with an electronic health recordMust be skilled in web navigation and use of mobile hotspots.Experience with Microsoft Office Word, Outlook, and Excel.

PREFERRED QUALIFICATIONS:

Certification in Case Management I.e., ACM (Accredited Case Manager) or CCM (Case Manager Certification) CCMUtilization ManagementProvider relationsMotivational interviewing Bilingual Spanish and English

Physical Requirements

Primary Duty

Percent of Time Performing Duty

Visual Acuity

YES

75-100%

Hearing

YES

75-100%

Standing

YES

75-100%

Walking

YES

75-100%

Lifting/Pulling/Pushing

YES

75-100%

Sitting

NO

0-24%

Reports To: Director of Nursing with a dotted line to Market Network Manager

PI256659378