RN Clinical Case Manager (San Juan, PR)

Clinical Care Manager

Position at Healthmap Solutions Puerto Rico Company Background Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

Position Summary

The Clinical Care Manager is responsible for developing and maintaining long-term relationships with physicians, physician office staff, and Healthmap members that are engaged in Healthmap's Kidney Management Program through coordinating performance improvement activities and care management to improve health outcomes.

Responsibilities

• Act as a liaison between Healthmap, provider practices and Healthmap members to ensure positive engagement and performance with our program(s)
• Develop new provider/partner business relationships that serve as means to better Healthmap provider and member engagement and manage assigned caseload
• Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider specific data
• Incorporate education and communication on Best Practice sharing, process improvement in provider workflows, Kidney Health Management interventions and HEDIS/STAR measures for identified areas of provider low performance
• Identify opportunities to educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc.
• Partner with physicians/physician staff to identify Healthmap Solutions members that would benefit from Care Navigation support, conduct outreach, and engage members in program
• Educate Healthmap members on kidney health, related co-morbid conditions, and renal replacement therapy
• Serve as Healthmap member advocate, utilize community resources and programs, and serve as liaison between the member, the member's support network, treating physician, and ancillary providers to assist members in meeting individualized goals
• Accountable for individual and departmental metrics and key performance indicators as identified by the organization
• Ensure timely and successful delivery of reports to internal and external stakeholders
• Maintain thorough documentation of all provider meetings/interactions and member interactions for consistency and coordination and in compliance with National Committee for Quality Assurance (NCQA) standards
• Ensure Healthmap policies and procedures are followed and complies with HIPAA privacy laws and all other federal, state, and local regulations
• Perform other related duties as assigned

Requirements

• Associate, diploma, or bachelor's degree in nursing required
• Active, unrestricted RN license required
• Basic Life Support (BLS) certification required
• Advanced Cardiovascular Life Support (ACLS) certification (based on role)
• 3+ years of progressive experience in healthcare services, clinical operations, quality, or care management
• 3 years of experience in care gap closure or care coordination activities, including those in an outpatient or hospital setting preferred
• Prior experience building and managing relationships with health care providers or patients preferred
• Proof of valid and unrestricted driver's license required and automobile insurance as required by law; this position requires regular travel within assigned region to support practices and or other healthcare/clinical sites as needed
• Bilingual fluency in English and Spanish
• On Island residency

As applicable, must comply with organization policies for health screening and immunizations, including but not limited to:

• Current Tuberculosis (TB) test or current chest X-ray
• Proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza)
• Participation in annual health and wellness screenings

Skills

• Excellent verbal, written and presentation skills
• Interpersonal skills to develop and maintain strong internal and external relationships
• Ability to multitask, prioritize, and create solutions in a fast-paced environment
• Demonstrated leadership skills and ability to create and maintain a positive work environment
• Strong critical thinking and analytical skills
• Ability to foster strong employee engagement among the team
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

This position requires regular travel within assigned region to support practices.

Americans with Disability Specifications The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.