RN Care Manager I

Role Overview

• The Care Manager works with Select Health members, their family, caregivers, and a multi-disciplinary care team in a collaborative process of assessment, planning, facilitation, navigation, coordination, evaluation and advocacy in order for member to access benefits, resources, and services to meet comprehensive medical, behavioral, and social needs of members while promoting self-management, quality, and cost-effective outcomes.
• The nurse care manager works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs.
• The position educates patients and caregivers to help them manage their health care needs.
• The incumbent facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management.
• This position is responsible for developing, documenting and implementing care plans, which will provide the appropriate resources to address social, physical, mental, emotional, spiritual, and supportive needs.
• Identifies members unable to adhere to a medical plan or members that require complex additional assistance and enrolls and follows these members in longitudinal care management services.
• Follows the applicable established model of care or care management program policies and procedures to assess, establish and maintain a plan of care which incorporates the member's individualized needs and goals within the benefit plan throughout the care management process.
• Ensures the plan is evidence based and consistent with goals and objectives of referral, payer contract, or established care processes.
• Maintains records by reviewing case notes, logging events and progress according to applicable regulatory requirements such as NCQA, CMS and State EQRO standards.
• Coordinates and facilitates communication among the member/family/representative, members of the healthcare team, and other relevant parties (e.g., other payers, Sales Team, Employer Groups, etc.) through interdisciplinary team meetings or other coordinated communication.
• Contacts patient at prescribed intervals and as necessary to determine if the goals are being achieved or if they continue to be appropriate and/or realistic.
• Determines variances and refers patients to a more comprehensive level of care if indicated.

Requirements

• Current license to practice as a Registered Nurse in the state of residence.
• Demonstrated experience and expertise working in clinical nursing
• Minimum 1-year experience in care management/navigation or closely related field including Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, quality, or patient educator job role.
• Strong written, verbal communication and conflict resolution skills
• Intermediate computer software and hardware skills, ability to customize computer settings and use multiple monitors and capable of independent troubleshooting internet and applications.
• RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.

Benefits

• We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.