ESSENTIAL SKILLS & ABILITIES

• Expert knowledge of all Medi-Share program guidelines and processes
• Excellent ability to communicate effectively with internal and external customers of all types in written, oral, telephonic, and digital formats that build engagement, interest, and facilitate positive outcomes
• Excellent researching, analytical, and critical-thinking skills
• Advanced planning and organizational skills; works effectively without supervision
• Advanced skill with Microsoft Office (Word, Excel, Outlook)
• Excellent computer skills – ability to access, research and use multiple software programs simultaneously and keyboard skills of at least 35 words per minute
• Ability to collaborate effectively and professionally with interdisciplinary team members, embers/patients, families, providers, facilities and other employees and departments
• Ability to comply with HIPAA and PHI requirements and all call compliance rules and regulations
• Strong ability to work independently and with a team
• Ability to handle conflict situations effectively
• Strong ability to adapt to changing processes
• Excellent ability to provide all content within a biblical framework

EDUCATION AND/OR EXPERIENCE

• Registered Nurse with a current unrestricted multi-state compact license or willingness to pursue required
• Bachelor of Science in Nursing required
• 3+ years nursing experience required
• 2+ years of case management and/or utilization management required
• Nurse coaching experience preferred
• Transitional care and transplant clinical experience highly preferred
• Have or willing to obtain a certification in either case management or managed care nursing within two years

ESSENTIAL JOB DUTIES & RESPONSIBILITIES

• Performs within licensed scope of nursing practice and under the direction of the Sr. Director, Clinical Services
• Identifies, screens, and enrolls members meeting criteria into Care Management Services
• Educates members and providers (as appropriate) regarding the Medi-Share provisions and processes
• Confirms member’s condition and plan of care are eligible for sharing based on Medi-Share and FDA/CMS approved evidence-based clinical management guidelines; suggests resources for those conditions/plan of care not eligible for sharing
• Identifies, educates, and facilitates member participation in appropriate member stewardship including, but not limited to patient assistance programs for medication, laboratory, and genetic testing
• Provides disease/condition specific clinical education to include multimedia resources, if available
• Identifies opportunities for and facilitates transitional care
• Partners with organizational resources to facilitate effective and cost-efficient outcomes for members
• Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
• Documents case work, all telephone conversations, correspondence, and tasks completely and accurately in appropriate IT systems
• Maintains and independently manages assigned caseload and departmental workflows within agreed service levels
• Presents accurate, complete, and concise case information to Sr. Director, Clinical Services within agreed upon service levels
• Completes medically related special projects independently as assigned with minimal supervision
• Attends all required departmental and organizational meetings
• Prays with members and providers as appropriate
• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
• Perform all other duties as assigned