This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2192475 Care Management Nurse
(Future Opportunities)
Remote within WA, OR, ID, UT. Candidates outside of these states will
not be considered.
Primary Job Purpose
The Care Management Nurse provides clinical care management (such as
case management, disease management, and/or care coordination) to best
meet the member\'s specific healthcare needs and to promote quality and
cost-effective outcomes. Oversees a collaborative process with the
member and those involved in the member\'s care to assess, plan,
implement, coordinate, monitor and evaluate care as needed.
**Please note this role is a candidate pool, and we are always
looking for top talent. We do not always have open positions but we
encourage you to submit your resume so you will be considered for all
open roles as they become available.**
General Functions and Outcomes
- Responsible for essential activities of case management including
assessment, planning, implementation, coordination, monitoring and
evaluation.
- Assessment: collection of in-depth information about a member\'s
situation and functioning to identify individual needs.
- Planning: identification of specific objectives, goals, and actions
designed to meet the member\'s needs as identified in the
assessment.
- Implementation: execution of the specific case management activities
that will lead to accomplishing the goals set forth in the plan.
- Coordination: organization, securing, integrating and modifying
resources.
- Monitoring: gathering sufficient information to determine the
plan\'s effectiveness and the evaluation phase should determine the
effectiveness of reaching the desired outcomes.
- Applies clinical expertise and judgment to ensure compliance with
medical policy, medical necessity guidelines, and accepted standards
of care.
- Utilizes evidence-based criteria that incorporates current and
validated clinical research findings.
- Practices within the scope of their license.
- Consults with physician advisors to ensure clinically appropriate
determinations.
- Serves as a resource to internal and external customers.
- Collaborates with other departments to resolve claims, quality of
care, member or provider issues.
- Identifies problems or needed changes, recommends resolution, and
participates in quality improvement efforts.
- Responds in writing or by phone to members, providers and regulatory
organizations in a professional manner while protecting
confidentiality of sensitive documents and issues.
- Provides consistent and accurate documentation.
- Plans, organizes and prioritizes assignments to comply with
performance standards, corporate goals, and established timelines.
Minimum Requirements
- Knowledge of health insurance industry trends, technology and
contractual arrangements.
- General computer skills (including use of Microsoft Office, Outlook,
internet search). Familiarity with health care documentation
systems.
- Strong oral, written and interpersonal communication and customer
service skills.
- Ability to interpret policies and procedures, make decisions, and
communicate complex topics effectively.
- Strong organization and time management skills with the ability to
manage workload independently.
- Ability to think critically and make decision within individual role
and responsibility.
Normally to be proficient in the competencies listed above
Care Management Nurse would have a/an Associate or Bachelor\'s Degree in
Nursing or related field and 3 years of case management, utilization
management, disease management, or behavioral health case management
experience or equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.*
Must have licensure or certification, in a state or territory of the
United States, in a health or human services discipline that allows the
professional to conduct an assessment independently as permitted within
the scope of practice for the discipline (e.g. medical vs. behavioral
health) and at least 3 years (or full time equivalent) of direct
clinical care
Must have at least one of the following: Certification as a case manager
from the URAC-approved list of certifications; or Bachelor\'s degree (or
higher) in a health or human services-related field (psychiatric RN or
Master\'s degree in Behavioral Health preferred for behavioral health
care management); or Registered nurse (RN) license (must have a current
unrestricted RN license for medical care management)
#LI-Remote
The expected hiring range for a Care Management Nurse is \$38.00 -
\$41.50 an hour depending on skills, experience, education, and
training; relevant licensure / certifications; and performance history.
The bonus target for this position is 10%. The current full salary range
for this role is \$33.8