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RN Clinical Case Manager (San Juan, PR)

Healthmap Solutions Puerto Rico
San Juan, PR

Apply Now

Job Details

Full-time
7 days ago

Qualifications

Spanish
Microsoft Excel
Microsoft Outlook
RN License
BLS Certification
English
Driver's License
Stakeholder relationship building

Full Job Description

Position Summary

The Clinical Care Manager is responsible for developing and maintaining long-term relationships with physicians, physician office staff, and Healthmap members that are engaged in Healthmap’s Kidney Management Program through coordinating performance improvement activities and care management to improve health outcomes.

Responsibilities

Act as a liaison between Healthmap, provider practices and Healthmap members to ensure positive engagement and performance with our program(s)
Develop new provider/partner business relationships that serve as means to better Healthmap provider and member engagement and manage assigned caseload
Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider specific data
Incorporate education and communication on Best Practice sharing, process improvement in provider workflows, Kidney Health Management interventions and HEDIS/STAR measures for identified areas of provider low performance
Identify opportunities to educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc.
Partner with physicians/physician staff to identify Healthmap Solutions members that would benefit from Care Navigation support, conduct outreach, and engage members in program
Educate Healthmap members on kidney health, related co-morbid conditions, and renal replacement therapy
Serve as Healthmap member advocate, utilize community resources and programs, and serve as liaison between the member, the member’s support network, treating physician, and ancillary providers to assist members in meeting individualized goals
Accountable for individual and departmental metrics and key performance indicators as identified by the organization
Ensure timely and successful delivery of reports to internal and external stakeholders
Maintain thorough documentation of all provider meetings/interactions and member interactions for consistency and coordination and in compliance with National Committee for Quality Assurance (NCQA) standards
Ensure Healthmap policies and procedures are followed and complies with HIPAA privacy laws and all other federal, state, and local regulations
Perform other related duties as assigned

Requirements

Associate, diploma, or bachelor’s degree in nursing required
Active, unrestricted RN license required
Basic Life Support (BLS) certification required
Advanced Cardiovascular Life Support (ACLS) certification (based on role)
3+ years of progressive experience in healthcare services, clinical operations, quality, or care management
3 years of experience in care gap closure or care coordination activities, including those in an outpatient or hospital setting preferred
Prior experience building and managing relationships with health care providers or patients preferred
- Proof of valid and unrestricted driver’s license required and automobile insurance as required by law; this position requires regular travel within assigned region to support practices and or other healthcare/clinical sites as needed
Bilingual fluency in English and Spanish
On Island residency

As applicable, must comply with organization policies for health screening and immunizations, including but not limited to:

Current Tuberculosis (TB) test or current chest X-ray
Proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza)
Participation in annual health and wellness screenings

Skills

Excellent verbal, written and presentation skills
Interpersonal skills to develop and maintain strong internal and external relationships
Ability to multitask, prioritize, and create solutions in a fast-paced environment
Demonstrated leadership skills and ability to create and maintain a positive work environment
Strong critical thinking and analytical skills
Ability to foster strong employee engagement among the team
Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

This position requires regular travel within assigned region to support practices.

#LI-Hybrid

Apply Now

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rn case manager jobs in puerto rico

RN Clinical Case Manager (San Juan, PR)

RN Care Manager - Hybrid (Bengali/Arabic/Chinese Languages Preferred)

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