Population Health Case Manager (Finance)

Requisition ID: 61581 Title: Population Health Case Manager Division: Arthrex, Inc. (US01) Location: Naples, FL.

Arthrex, Inc. is a global medical device company and a leader in new product development and medical education in orthopedics. Arthrex is actively searching for a Population Health Case Manager to improve the overall quality of the Arthrex Medical Center patients' lives by improving population health, enhancing the patient experience, coordinating efficient care, and reducing controllable costs. Join our talented team at a global medical device company focused on Helping Surgeons Treat Their Patients Better™ .

Essential Duties and Responsibilites:

• The case manager will collaborate & review data related to the health plan and admissions on a regular basis and coordinate care/programs as appropriate.
• Provides interaction with hospital/community resources including physicians, physicians' offices, community health care centers, management, and ancillary staff.
• Works with providers and referral options to coordinate care within provider network, including obtaining prior authorizations.
• Minimize fragmentation of care within the health care delivery system
• Improve outcomes by utilizing adherence guidelines, standardized tools, and proven processes to measure a client's understanding and acceptance of the proposed plans, his/her willingness to change, and his/her support to maintain health behavior change.
• Improve adherence to the plan of care for the client, including medication adherence.
• Deliver and coordinate direct nursing care when necessary.
• Provides educational consultation and facilitation and serves as a client advocate.
• Increase involvement of the individual and caregiver in the decision-making process.
• Improve healthcare literacy.
• Implements and maintains medical authorization and patient release of information documentation for case/disease management.
• Identify high-cost claims on health plan and intervene appropriately to reduce spend.
• Enters all relevant medical data into insurance provider's claim system or electronic health record.
• Assists with record keeping and billing.
• On a timely basis, communicates on all cases noting interventions and care planning.
• Works jointly with interdisciplinary efforts that focus upon moving the individual to improved health.
• Optimizes clients' satisfaction, clinic staff's time, and treatment room utilization by scheduling appointments in person or by telephone.
• Ensures availability of treatment information by filing and retrieving patient records as appropriate.
• Protects clients' rights by maintaining confidentiality of personal and financial information according to federal guidelines and regulations.
• Ensures availability of treatment information by filing and retrieving patient records as appropriate.
• Actively assist clinical staff in workflows and interventions to fully realize opportunities related to closing gaps in care while implementing cost saving opportunities.
• Develops and fosters relationships with internal and external partners, including insurance companies, to identify opportunities for increased quality of care in target population.
• Participates in monthly meetings with insurance representatives to gain a better understanding of quality measure benchmarks and standings.
• Performing chart reviews to extract data for necessary reporting.
• Performs other related duties incidental to the work described herein.

Education and Experience:

• Active registered nurse license in Fl, Multi state preferred.
• 5+ years case management and clinical experience required.
• Medical background required.
• Medical coding experience a plus
• Health coaching experience preferred.

Knowledge and Skill Requirements/Specialized Courses and/or Training:

• Excellent verbal and written communication skills.
• Ability to multitask in a high paced environment.
• Knowledgeable of privacy laws and ethics; HIPAA compliant
• Outgoing personality, highly organized, works well with others, friendly and dependable.
• Must demonstrate attention to detail, effective time management and flexibility.
• Knowledge of standard office practices and procedures.
• Demonstrate working knowledge of a self-insured health plan and various health states that include, diabetes, hypertension, obesity, metabolic syndrome, heart disease and hyperlipidemia,
• Ability to work independently with minimal supervision in a team-oriented environment.
• Must be willing to travel to all clinic locations.
• Bilingual a plus

Machine, Tools, and/or Equipment Skills:

Microsoft Office, PC and various specialized software.

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Arthrex Benefits

• Medical, Dental and Vision Insurance
• Company-Provided Life Insurance
• Voluntary Life Insurance
• Flexible Spending Account (FSA)
• Supplemental Insurance Plans (Accident, Cancer, Hospital, Critical Illness)
• Matching 401(k) Retirement Plan
• Annual Bonus
• Wellness Incentive Program
• Free Onsite Medical Clinics
• Free Onsite Lunch
• Tuition Reimbursement Program
• Trip of a Lifetime
• Paid Parental Leave
• Paid Time Off
• Volunteer PTO
• Employee Assistance Provider (EAP)

All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other status protected by law.