Intermountain Healthcare RN Care Manager - SelectHealth in Murray, Utah
Greater Salt Lake area
What does it mean to be a part of Intermountain Healthcare? It means that the quest for clinical excellence is not just a goal, but a given. It means building an environment where physicians and employees can deliver the best in healthcare. And it’s realizing each employee or volunteer is vital to the healing process, because we can only achieve theextraordinary together .
Being a part of Intermountain Healthcare means joining with a world-class team of over 36,000 employees and embarking on a career filled with opportunities, strength, innovation, and fulfillment. Our mission is: Helping people live the healthiest lives possible.
Our patients deserve the best in healthcare, and we deliver.
SelectHealth Care Managers provide one-time or ongoing help for our members. Although they operate differently than clinic or hospital nurses, our mission is the same: Helping People Live the Healthiest Lives Possible ® . As a care manager, you’ll help us provide superior service to our members.
Our current opening for RN Care Manager will support the pediatric and adult population within the Medicaid line of business. You will be given the opportunity to plan, implement, coordinate, monitor,and evaluate strategies for members and families. You will work personally with members and providers to ensure members get the most appropriate care.
Essential Job Duties
- Identification: Identifies patient populations using specific screening criteria or through referrals for service per department policy. Policy includes trigger list, time frames for assessing patient, and pre-screen criteria.
- Assessment: Reviews medical records, focused reports and/or referral information to gather relevant data. Obtains additional necessary information by interviewing the patient/family/significant other (SO). Assesses member per NCQA standards.
- Planning: Ensures a plan of care is developed and maintained for members receiving care management services consistent with NCQA standards. Develops plan of care using established evidence based care process models or care plans. Incorporates the member's individualized needs and goals within the benefit plan throughout the care management process.
- Implementation: Facilitates collaboration among all parties to reconcile differing points of view and assures that the wishes and needs of the member are understood. Supports and educates the member/family/representative to become empowered, self-reliant, and a self-advocate.
- Coordination: 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.). Coordinates with and acts as a resource to the facility Care Management staff to establish a plan of care for members who require assistance to transition from the facility to alternative levels of care, including documenting all activities related to the care management process and cooperating with all teams and other departments so issues can be resolved early. Maintains a current knowledge of community resources. Where necessary performs cost benefit analysis and coordinates negotiation of rates with providers and vendors through collaboration with the large claims auditors. Notifies appropriate individuals in the Sales, Actuary, Underwriting, and Reinsurer of any large dollar claims, high-risk members who require or will require intensive and/or costly services.
- Monitoring: 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.
- Evaluation of outcomes: Sets specific follow-up schedule with member. During the follow-up, conducts a thorough re-assessment of member's status and progress toward goal achievement. Documents and communicates progress toward reaching goals. Determines if the if adjustments are needed to the care plan and/or services to support member's ability to achieve established goals.
- Medical Cost Management: Using knowledge of member's benefits and resources, directs and assists members to appropriate facilities, health care resources, and other health management strategies. May participate in evaluations/recommendations related to provider/panel decisions regarding current service availability and quality of service.
- Professional: Consistently demonstrates an attitude of customer service excellence to internal and external customers. Participates on a variety of forums to improve department process, evaluate opportunities for appropriate cost-containment, and improve patient satisfaction.
- Demonstrates business management skills related to service cost evaluation, and complies with company policy/procedures/standards for appropriate referral coordination to community and private/public resources. Complies with all standards pertaining to accreditation (NCQA or other relevant body). Maintains a knowledge base of current medical practices.
- Meets productivity and performance standards defined by the department.
- Benefits Eligible: Yes
- Shift Details: Full-time Exempt, 40 hours per week. Hours are generally Monday through Friday, business hours.
- Department: SelectHealth - Care Management, Commercia line of business. (Murray, Utah).
- Bachelors degree in Nursing from an accredited institution (degree will be verified).
- Current RN license in state of practice.
- Three years of clinical nursing experience.
- Basic computer skills and knowledge of word processing and spreadsheet software.
- Ongoing need for employee to see and read information, assess member needs, and view computer monitors.
- Frequent interactions with providers, members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues accurately
- Manual dexterity of hands and fingers, this includes frequent computer use and typing for documenting member care, accessing needed information, etc.
- Case Management Certification.
- Experience working with third party payers.
- Knowledge of health insurance related products.
- Working understanding of coding and length of stay guidelines.
- Written and verbal communication skills.
- Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.
All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Working Hours 40
Primary Work Location SelectHealth
Job Type Full Time
Location US-UT-Murray, US-UT-Salt Lake City