Care Manager, Medicare Stars

Job DescriptionAssessment & PlanningMay conduct comprehensive assessments, which could include physical, psychosocial, and health literacy evaluation, and interprets relevant diagnostic data to identify member and family needs.Apply critical thinking skills to analyze complex cases, complete medication reconciliation post-discharge, and determine underlying causes contributing to high costs as applicable. Uses these insights to inform individualized transition/treatment plans and address gaps in care delivery.If applicable, partners with and empowers the member to develop an actionable care plan that helps prevent avoidable utilization.Care DeliveryConsistently follows through on all essential tasks and completes them within required timeframes to effectively close care gaps.Communicate results to internal and external departments and business partners as applicable.Communication & EducationIf applicable, assesses educational needs of members and families, ensuring clear and sufficient information is provided to facilitate active participation in care gap closure.Quality Improvement & LeadershipEngages in quality improvement initiatives, supports leadership in system-level improvements, analyzes dashboard data for program enhancement, and mentors new staff to promote best practices.Performs all other miscellaneous responsibilities and duties as assigned or directed.#LI-HybridJob RequirementsAt least three years of relevant clinical experience in medical-surgical, community or home health care, or equivalent experience in reviewing members' medical care and services.Must meet facility specified health screening/annual competency requirements.Demonstrates thorough expertise in care transitions with little supervision required.Possesses strong documentation and research abilities, can analyze information, make decisions, and communicate effectively both verbally and in writing.Displays interpersonal skills, resolves conflicts, and acts with integrity.Highly organized, able to multitask independently, fostering adaptability and teamwork.Performs well in a fast-paced setting and readily adapts to changes.Delivers outstanding customer service to both internal and external clients.Utilizes excellent analytical and critical thinking to evaluate medical necessity and the suitability of patient services and treatment individually.Safeguards patient privacy in accordance with Federal (HIPAA), organizational, and departmental regulations.Clearly communicates with providers and health care teams while building collaborative relationships.Intermediate working knowledge in Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.Experience with electronic medical records.Valid current Hawaii Registered (RN) or Registered Pharmacist (RPh).*(upon hire upon hire, proof of licensure to be provided by employee to Human Resources as well as a signed "Clinical Affirmation Statement for RN/LSW" form if applicable)Reliable transportation to perform in person (Face to Face) meetings with members in their home or in alternative settings.Job DetailsJob Type: Full-timeCategory: Healthcare Professionals (e.g. MA, RN, LSW)