U.S. healthcare today is confusing, inefficient and expensive. Maestro Health is on a mission to change that.
Our team of Maestronites (yep, that’s what we call ourselves) is revolutionizing not only the way we view health and benefits but also the way we live with our benefits.
We're owned by AXA and we’re growing fast. Really fast. So, we’re looking for hard-working, talented, passionate and like-minded people who want to join us on our mission.
Sound like a team you’d love to join? Good news for you: we’re hiring.
WHAT YOU WILL BE DOING:
We are looking for a Care Manager to join the Clinical Services Team. You will
serve in an expanded nursing role that includes assessment and identification of members with high-cost medical care; complex medical and social needs and those at high risk for complications or exacerbation from health-related conditions. You will also collaborate with members and their primary care providers to ensure the delivery of quality and cost-effective healthcare services.
- Apply case management process and standards of practice for member-specific assessment, goal setting, facilitation, and coordination of medically necessary and appropriate health care services.
- Develop an appropriate plan with the member using clinical knowledge, critical thinking and evidenced based best practice guidelines.
- Collaborate with a multi-disciplinary team that includes the member, family, primary care provider and facility staff, as appropriate, to ensure the coordination of services and effective transition of care across all continuums of care while considering the member’s physical health and psychosocial needs.
- Use a member-centric approach to promote appropriate use of resources and services to deliver efficient use of healthcare services to achieve optimal quality outcomes.
- Provide education to the member utilizing evidence-based clinical guidelines and reinforce the provider treatment recommendations and plan of care to support the member in an objective manner to empower them to be an advocate for their own medical and social needs.
- Implement, coordinate, and evaluates the member’s benefits, services, and outcomes to maximize the health of the member.
- Promote effective healthcare utilization, monitors health care resources and collaborates with the member, caregivers, and providers to achieve optimal clinical outcomes.
- Employ close monitoring of high-risk members to provide early intervention and cost containment strategies to ensure the member receives the most appropriate care at the appropriate level and at the appropriate time.
- Maintain members’ privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards and guidelines.
WHAT SUCCESS LOOKS LIKE:
- Demonstrate ability to work autonomously, establish priorities and accountability to achieve quality clinical outcomes.
- Demonstrate the ability to be flexible and function effectively in a fluid, dynamic, and rapidly changing healthcare environment.
- Demonstrate leadership qualities such as strong time management skills; verbal, written, and listening communication skills; problem solving and decision-making skills, delegation of appropriate tasks to other members of the internal healthcare team.
- Demonstrate strong interpersonal skills to effectively collaborate with practitioners, the interdisciplinary healthcare team, community agencies, members, and their family considering the member’s values, and religious and cultural beliefs.
- Achieve 90% on monthly quality audits.
- Maintain caseload target and billable hour targets as set by departmental policy.
- Perform other duties as assigned.
WHAT YOU NEED:
- Associate degree (ADN) in nursing required. A Bachelor’s Degree (BSN) in nursing preferred.
- Current RN license in the state of residence and willingness to apply for additional licenses as applicable.
- Current Certification CCM- Certified Case Manager, required.
- Minimum of five (5) years of experience in nursing and two (2) years in case management or managed care working with various payors and providers. Experience in managing patients with high-risk maternity, behavioral health, oncology, and transplant needs desired.
- Knowledge of basic managed care concepts and principles.
- Proficient in the use of technology for clinical documentation, task management and communication
- Valid driver’s license
WHY WORK AT MAESTRO HEALTH?
- Personal, Vacation and Sick Time
- Medical and Prescription
- Life and Disability
- Health and Wellness programs
- 401k with Employee Match
- Figo – Pet Insurance
We have great perks in each of our offices, along with a fun, energetic and fast-paced environment, and what will really drive you is our vision. Maestro Health is making employee health & benefits people-friendly again by making healthcare easy to understand, tools easy to use, and costs easy to control. We are aiming to become a household name within the employee health & benefits space.
We can’t do that without great people. We want to hear “WOW! That was the best job and business experience I ever had!” from every Maestronite – past, present, and future. You should be personally challenged, laugh, work your tail off and look forward to coming to work.
Are you ready to become a Maestronite? Let’s do this.
Maestro Health is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.