Health Services Member Care Manager SECUR

About this role

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing!

When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

Job Summary: The Health Services Member Care Manager is responsible for coordinating and managing the care of members enrolled in SECUR Health Plan. This role involves developing individualized care plans, conducting follow-up member visits, and ensuring members receive appropriate and timely care. The Member Care Manager will work closely with an interdisciplinary team, including the member’s Primary Care Provider, to provide comprehensive care and support to members of SECUR Health Plan. The role is member-facing, and the candidate will spend 90-95% of their work time in the field, directly interacting with members to provide care and support. In this role, the Health Services Member Care Manager must assess and make appropriate recommendations regarding the types of care and services that the member requires to improve their health and quality of life. Thorough communication with the interdisciplinary care team is crucial to ensure that all member needs are met, and that care is coordinated effectively to achieve the best possible health outcomes.

Key Responsibilities: • Health Risk Assessment (HRA): Completes initial and annual Health Risk Assessment (HRA) meeting all regulatory timeline requirements. Conducts comprehensive evaluation of potential health risks identifying exposure factors, analyzing data, and developing mitigation strategies to minimize health hazards in conjunction with the interdisciplinary team. This requires the RN to utilize their clinical expertise to identify subtle health risks and make informed decisions about the necessary interventions. • Care Plan Development: Develops and updates Individualized Care Plans (ICP) based on HRA results and changes in members' medical needs. Incorporates the member's stated goals and desires to ensure that the care plan is personalized and aligns with their preferences and aspirations. The RN must use critical thinking skills to assess the member's condition, anticipate potential complications, and adjust the care plan accordingly. • Member Follow-Up Visits: Conducts follow-up visits for members who have recently experienced post-acute discharges, falls, or have been assigned a risk score based on their most recent HRA. Conducts comprehensive assessments that include evaluating the member's clinical history, current medications, physical examination findings, psychosocial needs, functional status, and social determinants of health. The RN must make complex decisions regarding the member's care, considering multiple factors and potential outcomes. • Care Coordination: Coordinates follow-up appointments, specialist visits, and other outpatient services for members. Partners with other members of the Health Services Department to stay knowledgeable of the latest member information. The RN must use their clinical judgment to prioritize care needs and ensure timely access to necessary services. • Member Engagement: Conducts face-to-face visits with members to discuss care plans, assess progress towards goals, provide education, and ensure adherence to treatment. The RN must use their communication skills to effectively educate members and motivate them to adhere to their care plans. • Collaboration: Works with the interdisciplinary team to address members' health concerns and ensure access to quality care. The RN must collaborate with other healthcare professionals, leveraging their expertise to provide comprehensive care. • Documentation: Maintains accurate and timely documentation of all member interactions, care plans, and follow-up activities. The RN must ensure that documentation is thorough and reflects the member's condition and care plan accurately. • Community Engagement: Engages with community partners and stakeholders to implement comprehensive health program initiatives. The RN must use their knowledge of community resources to connect members with additional support services. • Preventative Health Initiatives: Assists in the design and implementation of preventative health initiatives and chronic care improvement programs (CCIP). The RN must use their clinical expertise to identify effective preventative measures and contribute to program development. • Educational Materials: Assists in the design and distribution of educational materials and trainings for members and partners within the community to raise awareness regarding health risks and preventative measures. The RN must use their knowledge to create accurate and informative educational content that is consistent with the latest approved clinical best practices and industry standards. • Compliance: Adheres to all federal, state, and accrediting body regulations, as well as SECUR Health Plan policies and procedures. Stays up to date on current compliance standards in terms of health and safety regulations, industry standards, and organizational policies. The RN must ensure that all care provided meets regulatory requirements and standards. • Audits and Inspections: Assists in periodic audits and inspections to identify potential member non-compliance issues in facilities and promptly reports to leadership and members of the Interdisciplinary Care Team (ICT) for intervention. The RN must use their attention to detail to identify compliance issues and take appropriate action. • Care Management and Chronic Condition Management Programs: Identifies, suggests, and collaborates with the interdisciplinary care team (ICT) on appropriate care management and chronic condition management programs that might benefit the member offered through SECUR Health Plan. The RN must use critical thinking and assessment ski

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