Call center Care Manager Day Shift

ROLE AND RESPONSIBILITIES

The role of the Call Center Care Manager is to use excellent listening skills to obtain detailed clinical information to assess callers’ healthcare needs particularly in an after hours telephonic setting. The registered nurse in this role is responsible for assessing symptoms utilizing evidence-based tools to determine dispositions and comfort measures. They coordinate continuity of care for patients often as a liaison between the patient, the patient’s family, provider and healthcare organizations, ensuring that the proper treatment is administered at the appropriate time to maximize health and well-being while also minimizing the need for hospitalization. The Clinical Call Manager strives to promote self-managed care and the use of healthcare resources in the most cost-effective way possible, working with patients of all ages and conditions. The individual in this position conforms to evidence-based practice and regulatory requirements.

FULL TIME Day-Shift-M-F

CORE FUNCTIONS

  • Care Performs telephonic nursing assessments utilizing the nursing process. Develops and implements a plan of care

  • Applies appropriate criteria for each level of care disposition

  • Collaborates with Medical Director when appropriate (i.e., communicates review findings, criteria not met, use of alternative care settings, determination of appropriate level of care, delay of provision of services, etc.) to insure appropriate, coordinated service delivery

  • Collaborates with the Provider or their designee to address the plan of care from an integrated approach as needed

  • Identifies and reports quality of care issues to the Medical Director and the VP of Medical Management

  • Communicates and collaborates with Medical and Nursing staff

  • Promotes the mission, philosophy, goals, and policies of the company through staff education

  • Completes clear and concise documentation in Call Management programs

  • Participates in Call/Case Review

  • Participates in departmental QI process

  • Provides clinical oversight of the call coordination process initiated by the Call Coordinators.

  • Maintains personal professional development.

  • Works closely with the Call Coordinator to keep all data entry accurate and up to date

  • Monitors delegated review activities as outline in each individual agreement

  • Active participant in care integration programs

  • Performs other duties as assigned

QUALIFICATIONS AND EDUCATION REQUIREMENTS

  • Must possess a current, active, unrestricted registered nursing license to practice in the state(s) assigned or maintain a compact license

  • Previous Call Center experience highly desirable

  • 3 years of various clinical experience

  • Ability to quickly ascertain severity of illness

  • Able to develop, implement, communicate and evaluate a plan of care for each call

  • Accountable and autonomous

  • Ability to handle multiple demands of diverse workload and prioritizes critical issues

  • Ability to utilize nursing skills to understand and coordinate care of those members that are significantly physically compromised by their illness and/or disability

  • Ability to effectively communicate verbally and in writing

  • Ability to build effective collegial relationships

  • Ability to influence and effect change

  • Ability to analyze and think critically

  • Ability to maintain a HIPAA compliant professional work environment

  • Possesses current knowledge of disease pathophysiology, psychosocial issues, and treatment

  • Positive, service-oriented attitude

  • High level of integrity

  • Computer literate


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