Health Payer Consortium- Seeking candidates for a Case Manager-RN
This key position is responsible for supporting the HPC Advantage Program by managing the client’s members who are experiencing a complex illness and/or condition. These cases require significant resources focused on their treatment plan.
Engage health plans with a focus on identifying high dollar claimants and matching the claimants needs with the optimal contract through the Advantage Program
Provide education and tools to promote the Program
Plan, implement, coordinate, and monitor the contract and related activities that may include acute and non-acute services and outpatient services
Conditions managed will include members who are progressing to organ failure and proceed to Organ Transplantation and/or targeted treatment plans such as CAR-T.
Working in partnership with the parties to ensure intervention and proper cash management is performed
2+ years related work experience in communicating and building relationships with clients and providers with utilization management experience
RN - Registered Nurse - State Licensure and/or Compact State Licensure
Experience in working with cases with complex and/or catastrophic illness and treatment plans that include Solid Organ Transplant
Experience with influencing and motivating individuals to change health behaviors
Experience in two or more of the following: home health care, utilization review, discharge planning, Case and Disease management
Experience working with Managed Care products, benefits and services
Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
Must have Transplant and Oncology
CCM - Certified Case Manager
This position is for a nurse to work in the St. Louis office.
HPC is a full suite cost containment organization serving the self-funded health plan industry for employer-based health plans. We employ claims professionals and medical professionals to assist our client's in effectively managing their health plan claims and offering plan members assistance with access to Centers of Excellence providers in the US.