RN Ambulatory Care Manager

Intermountain Health•Salt Lake, NM

7d•$45 - $67•Onsite

About The Position

The Central Market nurse care manager collaborates 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 health care needs, facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management. The role identifies patients who may benefit from care management, reviews records and referral information, gathers additional information from patients and caregivers, and assesses patients according to applicable CMS Conditions of Participation or NCQA standards. The nurse care manager develops and maintains individualized plans of care using established evidence-based care processes, and coordinates communication and services among patients, caregivers, clinicians, and other relevant parties. The position may perform cost-benefit analyses and other clinical duties as assigned.

Requirements

Current RN license in the state of practice.
Two years of clinical nursing experience.
RNs hired or promoted into this role must have or obtain a BSN within three years of hire or promotion.

Nice To Haves

Bachelor of Science in Nursing (BSN) from an accredited institution.
Case Management Certification.
Experience working in clinical care management or with third-party payers.
Knowledge of care management.
Knowledge of health insurance-related products.
Working understanding of coding, episode-of-care, and length-of-stay guidelines.
Written and verbal communication skills.

Responsibilities

Identify patient populations for care management through screening criteria, medical record reviews, or referrals, following department policies and guidelines.
Review medical records, reports, and referral information to gather relevant data.
Obtain additional information by interviewing patients, family members, or significant others.
Assess patients or members according to CMS Conditions of Participation or NCQA standards.
Develop and maintain plans of care consistent with applicable standards and department requirements.
Use established evidence-based care processes or care plans, incorporating each member’s individual needs and goals throughout the care management process.
Coordinate and facilitate communication among members, caregivers or representatives, health care team members, and other relevant parties.
Intervene to resolve or escalate barriers to services across the care continuum.
Maintain current knowledge of community resources.
Perform cost-benefit analyses and coordinate as necessary.
Perform other clinical duties as assigned.