Care Management Nurse

IMS MARKETING INC•Amarillo, TX

2d•$25 - $35•Onsite

About The Position

Position Purpose: To perform a systematic/situational analysis of the population healthcare needs as related to the Care Management program of IMS Wellness Works. To analyze, & evaluate program needs, and report organization need to the director of Utilization Management.

Requirements

Registered Nurse or LVN with 5 years current clinical experience (e.g. rehabilitation, critical care, trauma center, emergency):
Working knowledge of risk management, liability protection, community services, long term care planning
Excellent oral and written communications
Negotiation and persuasion skills
Strong organizational, time management, problem solving, and responsible decision-making skills
Team player with high degree of creativity and flexibility

Nice To Haves

BSN or equivalent degree in related field
2 years' experience in utilization management
Experience in a business or insurance area
Experience in Home Health, Hospice, public health or social services

Responsibilities

Performs preliminary screening based on referrals to assess eligibility of members for Care Management services when applicable.
Schedules and performs telephonic calls, and reviews with eligible members, including the review of preventative screening requirements
Completes outbound telephonic calls to all members with new Health Risk Assessments
Obtains all pertinent information from the member, and reviews appropriate care plans with members
Interacts and educates all members and related care givers of appropriate goals and interventions as they related to the Wellness Works or Chronic Condition Management program
Develops personalized care plans that addresses the health care needs of the enrolled member.
Coordinates the implementation of services in accordance with the members’ Benefit Plan when needed.
Refers members to Customer service or to vendor agencies when appropriate to obtain further services and other chronic care services.
Monitors, and evaluates Care Management services for enrolled members, including periodic direct member telephonic contact
Documents assessments, care plan goals, progress notes, and evaluations of care in the Deerwalk/Clinical Manager system in accordance with policies and procedures
Performs periodic review of Moderate Risk and High-Risk members as defined by the policies and procedures for Wellness Works
Maintains current knowledge of healthcare delivery protocols and trends, and all community resources available to the member /family.
Reviews policies and procedures for Care Management Nurse functions for Wellness Works, and reports needed changes to the Dir. of UM
Provides Clinical support to Care Management assistant when appropriate
Reports directly to the Director of UM
All other duties as assigned.