Birmingham: Disease Management Specialist

HealthSpring of Alabama, Inc. is dedicated to improving the health of the community we serve by delivering the highest quality and greatest value in health care benefits and services. We are seeking a Disease Management Specialist, I CCIP for our Health Services Department in our Birmingham office.

Primary Function:
The Disease Management Specialist, I CCIP functions under the direction of the CCIP/RRU Team lead/ Supervisor, to conduct outreach and screening for the Chronic Care Program, to identify member needs and barriers to care, and to implement selected interventions according to program guidelines. The Disease Management Specialist I interacts with members, physicians, providers, and other Alabama Healthspring staff to implement CCIP program interventions, track and document the members clinical progress, and to collect and evaluate the individual member outcomes. The Disease Management Specialist I conducts outreach calls as assigned to:
Identify members immediate and future case management, special needs, and condition specific educational needs
Improve and/or maintain the members health status and quality of life.
Educate and empower the member to become effective in the self-management of their chronic illness.
Increase members adherence to program guidelines by plan physicians.

The Disease Management Specialist interacts with members, providers, and other plan staff to implement selected program interventions, documents the activities, and refers to Alabama Healthspring clinical professional staff as appropriate and according to protocols.
The Disease Management Specialist I manages outreach and assessment of low risk members under the direction of the Team Lead/Supervisor. The Disease Management Specialist 1 must work towards mastering an understanding of chronic conditions that affect the Medicare population (Asthma, COPD, Diabetes, CHF, CAD and Hypertension).

Responsibilities:
The Disease Management Specialist conducts outbound member calls following scripted protocols meeting both productivity and performance expectations as identified by Team Lead/Supervisor. Conducts all calls in a courteous and customer service friendly manner.

Verifies member eligibility, reviews claims and pharmacy data to assess members current health status and utilization prior to placing the outreach call.

Documents HIPAA verification and members verbal agreement to participate in the CCIP program according to prepared script and protocols.

Using good listening skills conducts outreach calls collecting specific clinical and baseline data according to script, tools, and protocols. Refers member to a clinical RN/LVN when indicated by members response to questions.

Completes stratification and comprehensive assessment to identify care needs, and provide information on health care access and preventive health interventions and screening.

Establishes member specific interventions to be provided according to program guidelines, and care plans. Schedules follow up calls in accordance with assigned risk level and care level. Sets CCMS reminders appropriately. Meets team productivity requirements relative to outreach attempts and completion of follow up calls. Demonstrates progressive increase in productivity consistent with completion of training.

Collaborates with the member, members family, PCP and Team Lead RN, and reports on member progress. Seeks guidance when clinical outcomes and member responses indicate the need for assessment by a Registered Nurse or Licensed Practical Nurse.

Completes appropriate documentation according to policies and procedures into CCMS. Maintains documentation with each outreach call.

Communicates case specific information as indicated to the PCP. Information includes, but is not limited to member identification number, status of health screens and immunizations.

Assists members with: obtaining follow up physician appointments, and resolving transportation issues.

Documents activities as required data for the purpose of outcome measurement and reporting and to support the QI program.

Participates in program development activities and project work.

Performs other duties normally associated and consistent with this position including, but not limited to maintaining applicable regulations and standards required in the performance of this position, participating in regular continuing education, updating and developing policies and procedures, attending in-house meetings and rounds, etc.

Performs other related duties and projects as assigned.

Adheres to Alabama Healthspring policy and procedures.

Supports and carries out the Alabama Healthspring Mission & Values.

Attends required training as requested.

Complies with Alabama Healthspring and HIPAA confidentiality standards to protect the confidentiality of member information.

Supervisory Responsibilities: None

Job Related Skills:
Key Competencies/Success Factors:

Manage multiple priorities
Communicate effectively in person and via the telephone with members, physicians, health care providers, community resources, and others
Accurate, complete, and timely record keeping and documentation
Problem solving skills
Effective in providing information and education to members
Computer literate and proficient in use of commonly used software products, including, but not limited to word processing, spread sheets, database programs

ADA Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The position requires being seated for several hours a day. The employee must frequently speak and hear as well as utilize the telephone, computer, pen and paper. The employee is occasionally required to walk, and travel by car. The employee may occasionally present to small groups.

Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Primarily works in climate controlled based setting. The noise level in the work environment is usually quiet. Position requires that employee commute to off-site locations to complete Alabama Healthspring business. The employee is occasionally exposed to outside weather conditions.

Position Qualifications/Requirements:

Education and Training:
High School Diploma Required

Strongly prefer medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification

Experience:
Medical Terminology required desired
Prior member service or customer service telephone experience desired
Licenses, Registrations or Certifications
Certification as a para-professional, medical assistant, home health aide, or nursing assistant a plus
Valid drivers license with car insurance.


HealthSpring offers a competitive salary and full range of benefits. Please remember to include Resume and salary requirements. No phone call accepted.

Please apply via the URL: https://home.eease.com/recruit/?id=11190

HealthSpring of Alabama, Inc. is an EEO/AA employer.