Health Nurse – Medication Adherence

Position Summary

The Health Nurse - Medication Adherence focuses on ensuring the care beneficiaries receive is in accordance with established CMS Stars measures and the health plan’s DSNP Model of Care. This role involves a high degree of contact with Medicare members, contracted providers, provider office staff and healthcare institutions. The Health Nurse works with the care team to improve member compliance by collaborating with the member’s PCP and specialist(s). This role will involve working with the member to close clinical and pharmacy care gaps, mitigating non-clinical barriers to care, and facilitating the coordination of benefits as required. The position will require advanced interpersonal skills and professionalism. The ability to develop and maintain productive, positive relationships with members, providers and their staff is essential to the success of this position. The ability to motivate and influence provider practices to change and demonstrate effectiveness of action plans is also critical.

Essential Duties and Responsibilities
• Provides Telephonic Care Coordination to targeted members of high-risk populations
• Coordinates medication education and adherence with members, providers and pharmacy vendors in an effort to ensure member compliance with his/her medication regimen.
• Develops relationships with providers, pharmacies and health care institutions to identify and remove barriers to the health plans members achieving medication adherence
• Coordinates with members, families, and/or caregivers to help resolve barriers to care
• Coordinates with Case Management team to transition other identified care needs and gaps.
• Analyzes data from a variety of sources, including but not limited to claims, pharmacy, vendor data, HEDIS data and externally provided reports to assess member compliance.
• Documents all outreach and findings in appropriate systems
• Provides education to providers and office staff on the model of care, clinical practice guidelines, medical record documentation standards, HEDIS and Part D standards.
• Coordinate with Medicare Program Manager on interventions and follow up action items
• Escalates newly identified barriers to the Health Plan

Education, Experience and Qualifications
• Required to have education, training or professional experience in medical or clinical practice.
• LPN with 2-4 years of managed care or other health care experience.
• Strong electronic, written, and verbal communication skills.
• Experience working with practitioner offices (providing education, performing audits)
• Experience with CMS policies, HEDIS standards, and Clinical Practice Guidelines.
• Familiar with Clinical Practice Guidelines and can read, interpret, and articulate information to both internal and external constituents.

Knowledge, Skills and Abilities
• Ability to effect change, perform critical analysis and promote positive outcomes and facilitate empowerment for the member/family.
• Provide excellent customer service to external and internal customers.
• Excellent interpersonal and communications skills.
• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
• Ability to make decisions on next steps based on clearly established guidelines.
• Familiarity with HIPAA and PHI laws and requirements.
• Ability to maintain confidentiality and assume accountability.

Physical Requirements
• Please see Exhibit A

Computer Skills
• Substantial knowledge of Microsoft Office including SharePoint, Outlook, Teams, PowerPoint, Excel and Word

Affirmative Action/EEO statement

The Company provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Other duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Exhibit A

Checklist: Job Analysis/Job Description Physical Activities

Physical Activities

Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like.
☒ Never ☐ Occasionally ☐ Constantly

Moving self in different positions to accomplish tasks in various environments including tight and confined spaces.
☒ Never ☐ Occasionally ☐ Constantly

Remaining in a stationary position, often standing or sitting for prolonged periods.☐Never ☐Occasionally ☒ Constantly

Moving about to accomplish tasks or moving from one worksite to another.☒ Never ☐ Occasionally ☐ Constantly

Adjusting or moving objects up to 15 pounds in all directions.☐ Never ☒ Occasionally ☐ Constantly

Communicating with others to exchange information.☐ Never ☐ Occasionally ☒ Constantly

Repeating motions that may include the wrists, hands and/or fingers.☐ Never ☐ Occasionally ☒ Constantly

Operating machinery and/or power tools.☒ Never ☐ Occasionally ☐ Constantly

Operating motor vehicles or heavy equipment.☒ Never ☐ Occasionally ☐ Constantly

Assessing the accuracy, neatness and thoroughness of the work assigned.☐ Never ☐ Occasionally ☒ Constantly

Environmental Conditions

Low temperatures.☒ Never ☐ Occasionally ☐ Constantly

High temperatures.☒ Never ☐ Occasionally ☐ Constantly

Outdoor elements such as precipitation and wind.☒ Never ☐ Occasionally ☐ Constantly

Noisy environments.☐ Never ☒ Occasionally ☐ Constantly

Hazardous conditions.☒ Never ☐ Occasionally ☐ Constantly

Poor ventilation.
☒ Never ☐ Occasionally ☐ Constantly

Small and/or enclosed spaces.☒ Never ☐ Occasionally ☐ Constantly

No adverse environmental conditions expected.
☒ Never ☐ Occasionally ☐ Constantly

Physical Demands

Sedentary work that primarily involves sitting/standing.
☐ Never ☐ Occasionally ☒ Constantly

Light work that includes moving objects up to 20 pounds.
☐ Never ☒ Occasionally ☐ Constantly

Medium work that includes moving objects up to 50 pounds.
☒ Never ☐ Occasionally ☐ Constantly

Heavy work that includes moving objects up to 100 pounds or more.
☒ Never ☐ Occasionally ☐ Constantly

Job Type: Full-time

Pay: $50,000.00 - $65,000.00 per year

Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Work Location: Remote

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