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Care Manager

Charlotte, NC, United States

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Troy Medicare is hiring for 5 Care Managers who MUST reside in North Carolina. This is a remote work position. The Care Manager interfaces with members, providers and a multidisciplinary team that assesses, facilitates, plans and coordinates an integrated delivery of care across the continuum. Troy Medicare works to ensure that members progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

started in Concord, North Carolina when our founders saw so many people increasingly unable to afford their prescriptions. Big health insurance companies had become more expensive and less transparent in their pricing and benefits. Our mission is to provide a comprehensive and easy to understand Medicare plan for every single member.

Responsibilities

Completes clinical assessments of members per regulated timeliness and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers from the HRA.

Develops and implements a care management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.

Conducts telephonic visits as required.

Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventional achievement, and suggest changes accordingly.

Maintains ongoing member case load for regular outreach management.

Promotes integrations of services for members including behavioral health care and long -term services and supports to enhance the continuity of care for Troy members.

May implement specific Troy disease state management programs.

Facilitates interdisciplinary care team meetings and informal IDT collaboration.

Uses motivational interviewing to educate, support and motivate change during member contacts.

Assesses for barriers to care, provides care coordination and assistance to members to address concerns.

Collaborates with other care managers/supervisors as needed.

Participates in weekly IDT meetings.

Requirements

Current, unrestricted NC RN license or the ability to obtain

Minimum 2 years experience required with Dual Special Needs Plans (D-SNP)

Certified Case Manager (CCM), preferred

Basic understanding of insurance products, benefits, coverage limitations, laws and regulations as it applies to the health plan

Proficient in Google Suite as well as ability to work with multiple applications

Strong counseling or customer service background with ability to implement functional treatment plans

Candidate must reside in North Carolina and be home based (remote work)

Compensation

$70K to $75K plus benefits: health, dental, vision, life insurance and 401(k)

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. Work involves exerting up to 20 pounds of force occasionally and/or a negligible amount of force constantly to move objects. The use of arm and/or leg controls requires exertion of force greater than that for Sedentary Work and the worker sits most of the time, the job is rated for light work.

The company is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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