RN Case Manager

Nevada Health Centers I•Elko, NV

About The Position

The Registered Nurse (RN) Case Manager provides case management to Nevada Health Centers patients in a Patient Centered Health Home (PCHH) environment. The role delivers population management, wellness promotion, disease prevention, and chronic disease management for a select group of patients in a service area. It also 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 improve cost effectiveness by integrating case management functions to meet patients’ specific needs. The RN works with patients, providers, facilities, specialty networks, and other care resources to coordinate appropriate services and support high-risk patients.

Requirements

Graduate of an accredited nursing school.
Current registered nurse licensure in the state of Nevada.
Current CPR or BLS certification.
At least three years of experience in clinical practice, an emergency room, or an intensive care unit, 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 collaboratively with a team.
Computer literacy, including the ability to prepare complex reports and analyses.
Detail-oriented, with the ability to handle multiple and shifting priorities.
Ability to problem-solve, de-escalate and resolve conflict, and perform service recovery.
Ability to use the AIDET tool set effectively.
Demonstrated ability to produce consistently high-quality work and manage timelines and projects successfully.

Nice To Haves

Bachelor’s degree in nursing.
Prior clinical experience, preferably in an ambulatory, acute-care, skilled, or rehabilitation clinical 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.
Excellent people skills and customer-service acumen.
Ability to interact effectively and positively with other staff members.

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 healthcare 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.
Analyze clinical protocols to identify potentially unnecessary services or care settings and recommend alternatives when appropriate.
Use data reports and medical records to identify patients who are disconnected from the care system and proactively connect them with appropriate healthcare 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 use established screening criteria to identify members for case management or disease management activities and interventions.
Identify the highest-risk clients with 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.
Conduct patient encounters as needed.
Complete special projects, initiatives, and other duties as assigned.