Intermountain Healthcare Care Mgr II-Select Health in Salt Lake City, Utah

Job ID:214816
Greater Salt Lake area
Details:

About Us

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.

Job Description

To formulate, implement, coordinate, monitor and evaluate strategies for patients, families and health care team. Develop, document and implement plans, which will provide the appropriate resources to address social, physical, mental, emotional, spiritual, and supportive needs of the member. Act in a mentoring capacity to other Care Managers within Health Services.

Essential Job Duties

  • Identification. Identifies patient populations using specific screening criteria or through referrals for service per department policy. Policy includes trigger list, timeframes 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 all members receiving care management services consistent with NCQA standards. Ensures the plan is evidence based and consistent with goals and objectives of referral, payer contract, or established care processes. Coordinates and facilitates communication among the member/family/SO, primary care provider, members of the healthcare team, the payer, and other relevant parties (e.g. Sales, Brokers, Employer Groups, etc.). 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/SO to become empowered, self-reliant, and a self-advocate.
  • Coordination. 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. 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.
  • Monitoring. Contacts patient at prescribed intervals and as necessary to achieve identified goals and objectives. Compares the patient's course to established clinical pathways to determine variances and refer patient to more comprehensive level of care if indicated.
  • Evaluation of outcomes. Documents and communicates progress toward goals. Has a potential impact on quality and cost effectiveness due to directing members to appropriate facilities, health care resources and other health management strategies. Participates in evaluations/recommendations related to provider/panel decisions regarding current service availability.
  • Professional. Consistently demonstrates an attitude of customer service excellence to internal and external customers. Participates on a variety of forums (committees, work groups, etc.) 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 performance standards defined by the department.
  • Mentor. Works in a mentoring capacity with the Care Manager I's to assess appropriate level of care and develop alternative care to offset the disparity between plan design and treatment needed. Trains on and may handle more complex problem, questions and clinical circumstances. Works in collaboration with the department?s educator to foster an instructive and guiding atmosphere for Care Manager I?s. Provides an expert level of support for Care Manager I's as needed.
  • Quality Improvement. Initiates and/or participates in appropriate quality improvement activities. (Project Goal).

Posting Specifics

  • Entry Rate: DOE
  • Benefits Eligible: Yes
  • Shift Details: Full time, business hours
  • Located at the Select Health building
  • 5381 South Green Street Murray UT 84123
  • Additional Details: Position requires a Certified Case Manager designation or willing to obtain within one year of hire.

Minimum Requirements

  • Bachelor's degree in Nursing (BSN) from an accredited institution (degree will be verified).
  • Current Certified Case Manager (CCM) designation or it must be achieved within 12 months of hire/transition into this position.
  • Registered Nurse with a current license in the State of Utah (will be verified).
  • Five years of clinical nursing, quality assurance, home care, community health or occupational health experience, which includes at least one year of care management or utilization management experience.
  • Intermediate knowledge of word processing software.
  • Strong written and verbal communication skills.
  • Demonstrated ability to exercise critical thinking skills.

Physical Requirements

  • 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.

Preferred Requirements

  • Health insurance product knowledge.
  • Experience working with third-party payers.
  • A working understanding of coding and length of stay guidelines.
  • The ability to work independently, be self motivated, have a positive attitude, and be flexibility in a rapidly changing environment.

Please Note

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.

Additional Details:

Working Hours 40

Primary Work Location SelectHealth

Expertise Nursing

Job Type Full Time

Location US-UT-Salt Lake City