RN CASE MANAGER

Nevada Health Centers•Pahrump, NV

10d

About The Position

The Registered Nurse (RN) provides case management to NVHC patients in a Patient Centered Health Home (PCHH) environment. The role provides population management, wellness promotion, disease prevention, and chronic disease management for a select group of patients in a service area. The nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and evaluation of individual patient needs, in accordance with applicable Nevada Revised Statutes (NRS) and Nevada Administrative Code (NAC). The position aims to enhance the quality of patient management and satisfaction, promote continuity of care, and support cost effectiveness by integrating case-management functions to meet patients’ specific needs. The nurse manages members eligible for and requiring continuous, chronic, or high-intensity case management, and supports patients through education, care coordination, referrals, follow-up, and identification of appropriate healthcare options.

Requirements

Graduate of an accredited nursing school.
Current licensure as a registered nurse in the state of Nevada.
Current CPR or BLS certification.
At least three years of experience in clinical practice, the emergency room, or intensive care, with good clinical skills.
Familiarity with electronic health record systems.
Excellent people skills and customer-service acumen.
Ability to work independently under general instructions and as part of a team.
Valid driver's license and/or dependable transportation.
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.
Ability to interact effectively and positively with other staff members.
Detail orientation and ability to manage multiple and shifting priorities.
Ability to problem-solve, de-escalate and 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.
Prior clinical experience in an ambulatory, acute-care, skilled-nursing, or rehabilitation clinical setting.
Previous experience in case management or utilization management.

Responsibilities

Manage members who are eligible for and require continuous, chronic, 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 healthcare costs.
Coordinate services and referrals to health programs; handle inbound and outbound calls according to patient and business needs.
Track and support patients who receive services outside the practice, identify potentially unnecessary services or care settings, and recommend alternatives when appropriate by analyzing clinical protocols.
Use data reports and medical records to identify patients who are disconnected from the healthcare system and proactively connect them with appropriate care options.
Follow up with patients within a few days of an emergency room visit or hospital discharge.
Provide care-management services to high-risk patients.
Review clinical program information and use established screening criteria to identify members for case-management or disease-management activities and interventions.
Identify the highest-risk clients who have the greatest potential for improved health outcomes.
Manage network participation, specialty-network care, care involving durable medical equipment (DME) providers, and transfers to alternative levels of care using knowledge of benefit-plan design.
Complete patient encounters as needed.
Carry out special projects, initiatives, and other assigned duties.