Adherehealth Solutions Llc
The role of the Medication Case Manager is to facilitate HEDIs compliant patient care by working with physician offices, pharmacies and patients. The overall goal for case managers is to improve clinical outcomes, increase patient satisfaction, and promote cost-effectiveness. The MCM will work to improve population health through the resolution of drug therapy problems and facilitation of preventative screenings.
Education & Experience: Must possess an Associateās or bachelorās degree in nursing from an accredited school of nursing Current unrestricted state LPN/LVN or RN licensure from state of residence. LPN/LVN with 10+ years of medical office experience or RN with 5+ years of experience or 3 years of case management, utilization review or employer health benefits experience or equivalent combination of education and experience preferred. Minimum Physical Requirement: The MCM will perform his or her work in a general office environment using standard office equipment. The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job: Regularly lift and/or move up to 10 pounds Bend, twist or stoop on a repetitive and continuous basis Stand and remain on feet for extended periods of time Operate various business instruments, including computers, printers/scanners/fax machines, requiring manual dexterity Sit and concentrate for long periods of time to compute, examine, and interpret data Read paperwork and computer monitors, requiring visual acuity Skills: Proficient in Microsoft Word, Excel, Outlook and Google and ability to learn new software as needed Strong working knowledge of web-based applications Strong written and oral communication skills including ability to communicate effectively with all levels of healthcare personnel. Strong time-management skills and keen eye to detail Ability to deal with all situations in a calm and positive manner Ability to learn new processes quickly in a fast paced environment Strong interpersonal and persuasion skills Using critical thinking skills that involve analysis, research, and problem-solving to obtain resolution. Demonstrated ability to think critically and make decisions within individual role and responsibility
Telephonic outreach to providerās offices to inform of Drug Therapy Problems (DTPs) that have been identified from Medical and Pharmacy claims. DTPs include but are not limited to potential medication adverse reactions, potential cost saving alternatives and/or GAPs in medical care as indicated from AdhereHealthās clinical rules platform. Make outbound calls to patients to facilitate and coordinate medical care, including medications and preventative care. Work directly with patients to assess their needs (medical and SDOH) and connect them with essential services. Maintain confidentiality as related to patient information. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense. Maintain accurate and timely documentation Other Duties & Responsibilities: Applying sound judgment required to develop, modify and adapt procedures in order to most effectively meet demands in atypical situations. Participate in proactive team efforts to achieve departmental and company goals Provide leadership to others through example and sharing of knowledge/skill Other duties as required and assigned
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