RN - Care Manager
1 month ago
Job Description
SelectHealth is a not-for-profit community health plan serving more than 1 million members in Utah, Idaho, and Nevada. As part of an integrated system with Intermountain Healthcare, we share a mission of "Helping people live the healthiest lives possible" to ensure our members and the communities we serve have the highest quality healthcare at the lowest possible cost. SelectHealth's line of businesses (LOB) include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans and fully-funded and self-funded Commercial plan.
SummaryThe field care manager partners with members, their family and/or caregivers and providers so that they can self-manage their care, optimize their functional health status, have quality outcomes and use the health system appropriately. They are responsible for developing, documenting and implementing a program designed to address the medical, physical, mental, emotional, spiritual, social and supportive needs of the member. The field care manager facilitates ongoing program activities as well as provides care management services to program enrollees.
The field care manager can expect a majority of their time in the field visiting our members in their homes, in long-term care facilities, or in the community.
MUST LIVE IN IRON COUNTY, UTAH
DSNP Care Manager
ScopeThis position requires both remote work and local travel to meet members in their home's or community. Occasional in-office presence is required for meetings and training. Position reports to a Healthy Connections Program Manager or Director over a specific line of business. Conducts in-home, community-based and telephonic/video assessments and updates to care plan.
Job EssentialsIdentifies members who are unable to adhere to a medical plan without additional assistance and enrolls members who are willing to engage in care management services by reviewing referrals, records and conducting appropriate assessments.
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 (eg 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 patient to more comprehensive level of care if indicated.
Minimum Qualifications
- Bachelor's degree in Nursing (BSN) or Master's degree or higher in SW (LCSW or PhD) from an accredited institution (degree will be verified)
- Current RN or LCSW/PhD license in the State where care management services will be provided.
- Five years of clinical practice that may include quality assurance, home care, community health or occupational health experience
- -and-
- Reliable transportation and the ability to travel within assigned geographical region to meet members.
- -and-
- Strong written, and verbal communication and conflict resolution skills
- - and -
- Intermediate computer software skills in word processing and spreadsheet programs
- -and-
- Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment
Preferred Qualifications
- Certification in Case Management (CCM)
- Familiar with Motivational Interviewing
- Knowledge of government programs (ie, Medicare; Medicaid).
- Health insurance product knowledge.
- Experience working with third-party payers
- Ability to work independently and be flexible in a rapidly changing environment.
- 3+ years of relevant case management experience serving persons determined to have a Serious Mental Illness condition, individuals who are elderly and/or persons with physical or developmental disabilities
Ongoing need for employee to see and read information, assess member needs, and view computer monitors.
- and -
Frequent interactions with providers, members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues accurately
- and -
Manual dexterity of hands and fingers, this includes frequent computer use and typing for documenting member care, accessing needed information, etc.
Anticipated job posting close date07/08/2024
LocationValley Center Tower
Work CityMurray
Work StateUtah
Scheduled Weekly Hours40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$42.70 - $61.93
We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a 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.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion.
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
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