Creating remarkable health experiences, freeing people to be their best.
Care Manager RN - (Remote)
Location
United States
Posted
58 days ago
Salary
$68.4K - $105K / year
Seniority
Lead
No structured requirement data.
Job Description
Care Manager RN - (Remote)
Highmark Health
Company : Highmark Inc.Job Description : JOB SUMMARY This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. ESSENTIAL RESPONSIBILITIES - Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. - Function in accordance with applicable state, federal laws and regulatory compliance. - Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. - Promote quality and efficiency in the delivery of care management services. - Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. - Practice within the scope of ethical principles. - Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. - Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member. - Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. - Develop and sustain positive working relationships with internal and external customers. - Utilize outcomes data to improve ongoing care management services. - Other duties as assigned or requested EDUCATION Required - None Substitutions - None Preferred - Bachelor’s Degree in Nursing EXPERIENCE Required - 3 years of related, progressive clinical experience in the area of specialization - Experience in a clinical setting Preferred - Experience in UM/CM/QA/Managed Care LICENSES AND CERTIFICATIONS Required - Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided. Preferred - Certification in utilization management or a related field SKILLS - Working knowledge of pertinent regulatory and compliance guidelines and medical policies - Ability to multi task and perform in a fast paced and often intense environment - Excellent written and verbal communication skills - Ability to analyze data, measure outcomes, and develop action plans - Be enthusiastic, innovative, and flexible - Be a team player who possesses strong analytical and organizational skills - Demonstrated ability to prioritize work demands and meet deadlines - Excellent computer and software knowledge and skills Languages (Other than English) None Travel Requirement 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches/trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Does Not Apply Works primarily out-of-the office selling products/services (sales employees) Does Not Apply Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely, Occasionally Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $68,400.00 Pay Range Maximum: $105,900.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice
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Field Market Access Manager (3 positions: Warsaw, Poznan, Krakow)
Johnson & Johnson Innovative MedicineAt Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity.
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Job Function: Market Access Job Sub Function: Health Economics Market Access Job Category: Professional All Job Posting Locations: Warsaw, Masovian, Poland Job Description: About Innovative Medicine Our expertise in Innovative Medicine is informed and inspired by patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow. Join us in developing treatments, finding cures, and pioneering the path from lab to life while championing patients every step of the way. Learn more at https://www.jnj.com/innovative-medicine About the Role Johnson & Johnson Innovative Medicine is expanding and growing our Market Access Team. As part of this growth, we are seeking to hire three Field Access Managers. This is a field-based role available in multiple cities within Poland. While specific cities are listed in the Locations section for reference, please note that they are examples only and do not limit your application. We invite candidates from various locations to apply and encourage you to review the following cities where this opportunity is available: 1. Warsaw + Olsztyn + Białystok + Lublin (candidate’s residence: Warsaw). 2. Poznań + Gdańsk + Szczecin + Zielona Góra + optionally Bydgoszcz (candidate’s residence: Poznań/Gdańsk). 3. Rzeszów + Katowice + Kraków + Łódź (candidate’s residence: Kraków/Katowice). Key Responsibilities: General - Establish and maintain relationships with key hospitals to quickly identify access barriers, needs, trends and opportunities to collaborate; develop strategic plan and act on it to improve access to J&J products. - Constantly monitor the execution of drug program, spendings and any changes and movements – develop a plan to optimize it and support execution through collaboration with key external and internal stakeholders. - Monitoring the external environment, legislation changes and its impact on the local hospital level. - Provide business and market information analysis about the hospital market and its development (to inform strategic decisions). - Support national reimbursement process by collecting necessary data and insights. - Provide training and upscale internal team to have a proper understanding and knowledge about the HC system, constant changes and implications. Specific - Making sure the right budgets are allocated for a given drug program J&J has medicines in (before reimbursement and within entire product life cycle), support the shifts of the budget between drug programs and hospitals in compliance with local regulations – cross-functional collaboration with local NHFs, hospital Directors (administration) and national & voivodship’s consultants. - Securing patients access at Day 1 of the validity of the reimbursement decision (working with public procurement departments of the hospitals). - Ensuring proper settlement of drug programs related to J&J drugs and associated RSS mechanisms at the hospital level. - Support for the hospital administration in the field of funding mechanism and settlement for diagnostics, services and additional procedures relevant to J&J products (making sure these are adequately financially evaluated – and drive the right evaluation, if necessary, in cooperation with National Consultants and NHF). Qualifications: - Minimum 3 years of experience in Field Market Access and proven track record of independently managing projects. - Ability to understand the organizational strategy and apply to product pricing strategies with excellent knowledge of NHF regulations and healthcare process for hospital funding. - Demonstrate a comprehensive knowledge of the Polish HC system, market dynamics, policy, pricing and access pathways, including its processes and key stakeholders. - Solid knowledge of Pharmaceutical Law, Reimbursement Law, NHF regulations, Public Procurement Law, principles of hospital procedures settlement. - proven track record of working with external clients (hospital administrations, NHF, etc.). - Strong analytical skills, ability to drive conclusions informing strategic decisions from the dataset. - Strong with Excel and Point, proven track of working with databases. - Fluent English spoken and written. The anticipated base pay range for this position is PLN 231,000 to PLN 399,050. In addition to base pay, we offer the following benefits*: an annual bonus with set target (% of pay) depending on pay grade / location, where the actual amount is based on the employees’ and companies’ performance of the previous calendar year, or sales commissions. Moreover, we offer vacation days, parental leave for a minimum of 12 weeks, bereavement leave, caregiver leave, volunteer leave, well-being reimbursement, programs for financial, physical and mental health. We also offer service anniversary and recognition awards, and subject to the terms of their respective plans, employees - and in some location’s eligible dependents - can participate in several insurance plans. For more information, visit Employee benefits | Supporting well-being & career growth | Johnson & Johnson Careers. *This is for informative purposes only. Amounts and actual benefits may vary by location and are subject to change. Required Skills: Preferred Skills:


