Registered Nurse - SHP Care Management (Remote/Hybrid within member service area)

Sanford Health • Marshfield, WI

8d • Hybrid

About The Position

The Care Manager - RN is a Registered Nurse (RN) who functions as an integral member of the Case Management Team of Security Health Plan. The RN is responsible for the assessment, coordination, planning, and implementation of case management services. S/he is also responsible for carrying out the management of specific, individual medical episodes identified through utilization review, disease management, and quality assurance functions. This individual ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first. This position is from work from home. Home visits and travel will be needed as part of the DSNP program and Model of Care. Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first. Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program . Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Requirements

• Graduate of an accredited school of nursing
• Five years clinical experience in home health, nursing home, hospital, community outreach care, case management, utilization management, and/or discharge planning.
• Experience with keyboard, computer, and general office equipment.
• Registered Nurse with valid, unrestricted Wisconsin nursing license
• Must complete CPUR or CPUM certification and case manager certification within two years of hire.
• Current State of Wisconsin Registered Nurse License or Nurse Compact License.
• Basic Life Support (BLS) certification awarded by the American Heart Association (AHA) within three months of hire.
• Valid driver’s license required with an acceptable record.
• Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid.

Nice To Haves

• Bachelor's degree in nursing preferred.
• Experience in quality assurance/improvement.
• Knowledge of insurance, BadgerCare/Medicaid, and Medicare requirements
• Utilization Review and/or case management certification.

Responsibilities

• responsible for the assessment, coordination, planning, and implementation of case management services
• responsible for carrying out the management of specific, individual medical episodes identified through utilization review, disease management, and quality assurance functions
• evaluating the effectiveness of alternative care services
• ensuring cost effective, quality care is maintained
• Face to face visits with SHP DSNP members and travel is included in this position (primary work area Marshfield/Wood County with Clark and Taylor counties being secondary).
• a face to face visit will be completed annually with every enrolled DSNP member.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed