RN Care Manager I

Intermountain Health • SelectHealth - Murray, GA

4d • $40 - $61 • Remote

About The Position

Select Health is a community health plan serving more than 1 million members. Select Health’s line of businesses include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and self-funded Commercial Employer plans. 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. Essential Functions 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.
• If primary state of residence (PSOR) is part of the Nurse Licensure Compact, must have a compact state license within 60 days of hire.
• If work assignment is in a non-compact state, must obtain a single state license per state(s) assigned within 60 days of hire.
• If PSOR is in a non-compact state, will need a license in the state you reside, and within 60 days of hire must obtain a Utah license, and other state licenses dependent on work assignment.
• 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.

Nice To Haves

• Bachelor's degree in nursing (BSN) from an accredited institution (degree will be verified).
• Case Management Certification.
• Three years of experience and expertise working in clinical nursing in an ambulatory care setting, community health or home care.
• Experience working with third party payers.
• Ability to work independently and be flexible in a rapidly changing environment.
• Demonstrated excellent written and verbal communication skills.
• Experience working successfully in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook.
• Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.

Responsibilities

• Works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs.
• Educates patients and caregivers to help them manage their health care needs.
• Facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management.
• Develops, documents, and implements care plans to address social, physical, mental, emotional, spiritual, and supportive needs.
• Identifies members unable to adhere to a medical plan or requiring complex additional assistance and enrolls them in longitudinal care management services.
• Assesses, establishes, and maintains a plan of care incorporating member's individualized needs and goals within the benefit plan.
• Ensures the plan is evidence-based and consistent with referral goals, payer contracts, or established care processes.
• Maintains records by reviewing case notes, logging events and progress according to applicable regulatory requirements (NCQA, CMS, State EQRO).
• Coordinates and facilitates communication among the member/family/representative, healthcare team, and other relevant parties.
• Contacts patients at prescribed intervals to determine if goals are being achieved or remain appropriate/realistic.
• Determines variances and refers patients to a more comprehensive level of care if indicated.

Benefits

• 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.
• Tuition coverage paid directly to the academic institution through the PEAK program.
• 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates.
• PEAK program eligibility on day 1 of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level