RN-Care Manager-Evernorth-Colorado

Clinical Integration


* Identifies and builds effective relationships with local network providers.


* Works effectively with CareAllies's internal team to support coordination of care and data analysis.


* Thoroughly reviews patient level actionable data to support identification of eligible customers and creates processes and procedures for outreach and engagement.

Health Information Line follow up calls

Outreach to customer with a Steerable ER visit

Outreach to customers with Out of Network spend


* Drives appropriate outreach, engagement, and positive clinical outcomes through timely information exchange with matrix partners.


* Acts as a primary liaison for the customer, partnering with internal programs (i.e.

complex case management, specialty case management), external programs (i.e.

community providers, specialists), and all matrix partners to support positive outcomes.


* Establishes and maintains a positive, professional, and collaborative relationship with customer/employee, employer, providers of care, and partners to support improved outcomes (clinical, quality and cost) of aligned employee population.


* Develop and implement engagement strategies defined by identified population needs.

Care Coordination


* Supports care coordination for individual customers, focusing on the high-risk targeted population to ensure efficient, high-quality, and cost-effective care.


* Provides steerage and referrals to high quality network providers.


* Refer appropriate individuals to eligible programs within CareAllies and all eligible client specific health and wellness programs.

Patient Engagement

Coaching


* Enhances customers' abilities to interact effectively with their providers.


* Provide education and research relevant topics as needed to support customer inquiries.


* Collaborates with customer in creation of care plan, establishing goals and interventions, and documents plan in medical management system.


* Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.


* Communicates effectively through verbal and written modes of interaction, including telephonic, email, text, and direct messaging.


* Identifies gaps in care and works with customers, providers, and/ or local community resources to close gaps in care.


* Acts as resource to direct customers with specific non-clinical questions to the appropriate resource.

Benefit Navigation


* Refer to client contact for detailed plan questions, concerns, and issues requiring escalation.


* Education and referrals to plan clinical programs and resources (internal and external).


* Assist employees with health care professional referrals, (e.g., primary care physician or specialist referrals in the plan network).


* • Current Licensure as a registered nurse, in the state of residency, in good standing.

• Associa...