Job Description

Scope:  

The Disease Manager/Total Lifestyle Coach (TLC) / Complex Condition Manager (CCM) will have direct responsibility for managing an individual caseload using Disease, Complex Condition and Population Health Management constructs. T his is a remote/work-from-home position.

Licensure/Certification Requirements: 

• Registered Nurse (current unrestricted, in state of practice) 

Experience:  

• Minimum of three years of clinical experience including at least two years of chronic Disease Management and patient teaching in any setting preferred. 

• Good keyboarding skills and computer literacy preferably with Microsoft Office applications and with internet. 

Requirements/Skills: 

• Good organizational skills and time management  

• Excellent verbal and written communication skills  

• Ability to handle difficult situations tactfully and diplomatically.   

• Effective problem solving and decision-making skills.  

• Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint)  

Duties and Responsibilities:  

• The Disease Manager/Total Lifestyle Coach (TLC) will practice within the scope of his/her licensure. The Disease Manager/TLC operates under the express direction of the Supervising RN. 

• Collect and document patient information to facilitate the patient assessment and formulation of a plan of care. 

• Continuously gather, update and review information to include (but not limited to) collecting medical records, history, assessment information. 

• Guide, coach and encourage the patient in following the plan of care. Instruct the participant regarding both short and long-term goals and offer guidance as to how to meet those goals. Document actions taken and interventions provided throughout the process. 

• Collaborate with providers, payers, and participants to ensure that the participant has access to appropriate resources. 

• Contact the payer to determine benefits and any constraints that may impact the plan of care. 

• Access to member benefit information is available through the Group Screen in MWCMS. All programs and benefit resources are TPA and Group specific. MedWatch does not interpret benefits. The member is referred to their benefit manager at the TPA for any benefit and eligibility questions upon request. 

• Make arrangements for quality care according to the needs of the participant, the physician’s orders and available benefits. 

• Maintain a current up-to-date working knowledge of alternative treatments. If there are no benefits available for recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the participant’s medical condition and will be cost-effective to the benefit plan. 

• Become familiar with community resources or other funding sources that will allow the participant to receive quality care and conserve health benefit dollars. 

• Maintain documentation in the computer system. Complete all aspects of case in the computer. 

• Maintain on-going contact with providers and participants to ensure that the participant’s needs are being met. 

• Take actions upon any awareness of non-medical issues which involve the participant’s safety or welfare and attempts to direct the participant or family to appropriate providers or community resources, or to personally notify appropriate authorities. 

• Consult with the Director of Population Health Management on a regular basis. Keep the director informed regarding any complaints which may occur about Disease Management services or any issues which arise which the Disease Manager is not competent to handle or does not have the expertise to handle. 

• Use good organizational skills to manage time and resources efficiently. 

• Use effective writing style to organize information and thoughts and present them clearly and concisely in writing for prepared reports, correspondence, etc. 

• Use effective teaching strategies during contacts with patients by telephone and in selecting appropriate educational materials. Use effective listening techniques to identify where the patient is in their stages of behavior change and respond appropriately. 

• Seek opportunities for personal growth and development. Remain up-to-date on health and wellness topics as well as current treatment options for chronic medical conditions. Keep abreast of new trends and practices in the field of Disease Management. 

• Maintain a professional attitude and approach at all times using tact, courtesy, self-control, patience, loyalty, and discretion to work harmoniously with others. Maintain the ability to adapt to new situations and changing work responsibilities. 

• Adhere to all department and company policies and procedures. 

• Participate in onsite and offsite employee health fairs as needed. Provide individual or group teaching and/or facilitate support groups focused on a chronic disease topic. 

• Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers. 

• The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice. 

The salary for this position is $62,000.00 to $74,000.00 annually

Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer.  Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.   

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