Registered Nurse Care Manager Commercial
2 weeks ago
Job Description:
SelectHealth is a not-for-profit community health plan serving more than one 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.The Care Manager 1 - Remote is a Registered Nurse who 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.
Develop, document, and implement plans, which will provide the appropriate resources to address social, physical, mental, emotional, spiritual, and supportive needs.
This position is primarily remote with occasional in-office presence for meetings and training. Position reports to a Healthy Connections Director. Conducts telephonic or video assessments and updates to care plans
Job Essentials
- Identifies 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 (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 patient to more comprehensive level of care if indicated.
Minimum Qualifications
- RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.
- Current RN (Nurse) compact license to practice in all states that are part of the compact .
- Demonstrated experience and expertise working in clinical nursing in an ambulatory care setting
- Experience in care management or managed care or health promotion/coaching or behavioral health or Patient
- Educator job role or care navigation role
- Strong written, and verbal communication and conflict resolution skills
- Experience working successfully working in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook; Capable of troubleshooting internet connection
- Basic computer hardware set-up, ability to customize computer settings and use multiple monitors
Preferred Qualifications
- 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.
- Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.
Physical Requirements:
Interact with others requiring the employee to communicate information.
Operate computers and other office equipment requiring the ability to move fingers and hands.
See and read computer monitors and documents.
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.
Anticipated job posting close date:
09/30/2024Location:
SelectHealth - MurrayWork City:
MurrayWork State:
UtahScheduled Weekly Hours:
40The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$39.99 - $59.18We 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 todiversity, 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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