RN Case Manager

Nevada Health Centers I•Pahrump, NV

10d

About The Position

The Registered Nurse (RN) provides case management to Nevada Health Centers (NVHC) patients in a Patient Centered Health Home (PCHH) environment. The role supports population management, wellness promotion, disease prevention, and chronic disease management for a select patient group in a service area. The RN provides ongoing expertise through comprehensive assessment, planning, implementation, and evaluation of individual patient needs, consistent with applicable Nevada Revised Statutes and Nevada Administrative Code. The position aims to improve the quality of patient management and satisfaction, promote continuity of care, and support cost-effective care by integrating case management functions to meet each patient's needs. The RN manages patients who require continuous, chronic, or high-intensity case management; coordinates care, referrals, and follow-up; and provides education and coaching to help patients make informed decisions. The role uses clinical criteria, data reports, and medical records to identify patients who may benefit from case or disease management and to connect patients with appropriate care options.

Requirements

Graduate of an accredited nursing school.
Current license as a registered nurse in the state of Nevada.
Current CPR or BLS certification.
At least three years of experience in clinical practice, the ER, or ICU, with good clinical skills.
Familiarity with electronic health record systems.
Valid driver's license and/or dependable transportation.
Ability to work independently under general instructions and as part of a team.
Strong people skills and customer service acumen.
Ability to interact effectively and positively with other staff members.
Detail-oriented, with the ability to handle multiple and shifting priorities.
Ability to problem-solve, de-escalate or resolve conflict, and perform service recovery.
Ability to effectively use the AIDET tool set.
Demonstrated ability to produce high-quality work consistently and manage timelines and projects successfully.
Computer literacy, including the ability to prepare complex reports and analyses.

Nice To Haves

Bachelor’s degree in nursing.
Previous clinical experience in an ambulatory, acute care, skilled nursing, or rehabilitation setting.
Previous experience in case management or utilization management.
Knowledge of office laboratory procedures and pediatric and adult phlebotomy skills.
Knowledge and skill in pediatric and adult medication and immunization administration.
Knowledge of the essential functions, practices, and procedures of a medical clinic and office, including in-office procedures.

Responsibilities

Manage members who are eligible for and require continuous, chronic, and/or high-intensity case management.
Provide health education and coach patients on treatment alternatives to support informed decision-making.
Support patients in selecting physicians and facilities to maximize access and quality while managing health care costs.
Coordinate services and referrals to health programs.
Take inbound calls and place outbound calls according to patient and business needs.
Track and support patients who obtain services outside the practice.
Identify potentially unnecessary services and care settings by analyzing clinical protocols, and recommend alternatives when appropriate.
Use data reports and medical records to identify patients who are disconnected from the system and proactively connect them with appropriate health care options.
Follow up with patients within a few days of an emergency room visit or hospital discharge.
Provide care management services for high-risk patients.
Review clinical program information and apply established screening criteria to identify members for case management, disease management, or related interventions.
Identify the highest-risk clients who offer the greatest potential for improved health outcomes.
Manage network participation, specialty-network care, DME-provider care, and transfers to alternative levels of care using knowledge of benefit plan design.
Provide patient encounters as needed.
Perform special projects, initiatives, and other assigned duties.