Care Manager Nurse

IMS MARKETING INC•Amarillo, TX

2d•$30 - $32

About The Position

The Care Manager Nurse performs systematic and situational analyses of population healthcare needs related to IMS Wellness Works Care Management. The role analyzes and evaluates program needs and reports organizational needs to the Director of Utilization Management. The nurse independently assesses and delivers care management services in accordance with care management guidelines, providing oversight for 25,000 lives. The position screens referrals for member eligibility, conducts telephonic reviews and Health Risk Assessment follow-ups, gathers member information, develops and reviews personalized care plans, and educates members and caregivers about goals and interventions. It coordinates services under members’ benefit plans, makes referrals to customer service and vendor agencies, and monitors and documents care management services and outcomes in the Deerwalk/Clinical Manager system. The nurse also reviews moderate- and high-risk members, keeps current on healthcare protocols and community resources, reviews care management policies and procedures, and provides clinical support to the Care Management Assistant when appropriate. The position reports directly to the Director of Utilization Management.

Requirements

Registered Nurse or LVN.
Five years of current clinical experience, such as rehabilitation, critical care, trauma center, or emergency experience.
Working knowledge of risk management, liability protection, community services, and long-term care planning.
Excellent oral and written communication skills.
Negotiation and persuasion skills.
Strong organizational, time-management, problem-solving, and responsible decision-making skills.
Ability to work as a team player with a high degree of creativity and flexibility.
Basic computer skills, including Word, Excel, and Access.
Ability to communicate tactfully, diplomatically, and effectively.
Legible handwriting for documentation.

Nice To Haves

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

Responsibilities

Perform preliminary screening of referrals to assess member eligibility for Care Management services when applicable.
Schedule and conduct telephonic calls and reviews with eligible members, including reviewing preventive screening requirements.
Make outbound telephonic calls to members with new Health Risk Assessments.
Obtain pertinent information from members and review appropriate care plans with them.
Interact with and educate members and caregivers about appropriate goals and interventions for the Wellness Works or Chronic Condition Management program.
Develop personalized care plans addressing enrolled members’ healthcare needs.
Coordinate implementation of services in accordance with members’ Benefit Plans when needed.
Refer members to Customer Service or vendor agencies for further services and chronic care services when appropriate.
Monitor and evaluate Care Management services for enrolled members, including periodic direct telephonic contact.
Document assessments, care plan goals, progress notes, and evaluations of care in the Deerwalk/Clinical Manager system in accordance with policies and procedures.
Periodically review Moderate Risk and High Risk members as defined by Wellness Works policies and procedures.
Maintain current knowledge of healthcare delivery protocols, trends, and community resources available to members and families.
Review policies and procedures for Wellness Works Care Management Nurse functions and report needed changes to the Director of Utilization Management.
Provide clinical support to the Care Management Assistant when appropriate.
Perform other duties as assigned.