RN Ambulatory Care Manager

About the role

The Central Market nurse care manager works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs. The position educates patients and caregivers to help them manage their health care needs. The incumbent facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management.

Responsibilities

• Identifies patient populations using specific screening criteria, medical record review, or referrals for service per department policy/guidelines (includes trigger list, timeframes for assessing patient, and pre-screen criteria).
• Reviews medical records, focused reports, and/or referral information to gather relevant data per department guidelines.
• Obtains additional necessary information by interviewing the patient/family/significant other (SO).
• Assesses patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards.
• Ensures a plan of care is developed and maintained for members receiving care management services consistent with COP/NCQA and department standards.
• Develops plan of care using established evidence-based care process models or care plans.
• Incorporates the member's individualized needs and goals during the episode of care and within the benefit plan throughout the care management process.
• Coordinates and facilitates communication among the member/caregivers/representative, members of the healthcare team, and other relevant parties (e.g., referral physicians, community organizations, post-acute providers, other payers, Sales Team, Employer Groups, etc.).
• Actively intervenes and resolves/escalates barriers to service across the care continuum.
• Maintains current knowledge of community resources.
• Performs cost-benefit analysis and coordinates as necessary.
• Performs other clinical duties as assigned.

Requirements

• Current RN license in state of practice.
• Two years of clinical nursing experience.
• RNs hired or promoted into this role must have or obtain a BSN within three years of hire or promotion.

Preferred qualifications

• Bachelor's degree in Nursing (BSN) from an accredited institution (degree will be verified).
• Case Management Certification.
• Experience working in clinical care management or with third-party payers.
• Knowledge of care management.
• Knowledge of health insurance related products.
• Working understanding of coding, episode of care, and length of stay guidelines.
• Strong written and verbal communication skills.
• Ability to operate computers and other office equipment requiring fine motor skills.
• Ability to see and read computer monitors and documents.
• Ability to remain sitting or standing for long periods to perform work on a computer, telephone, or other equipment.

Schedule

Full-time (40 hours per week), Monday–Friday 8:00 AM–4:30 PM, with two days per week in clinic. Location: Salt Lake Clinic, Salt Lake City, Utah.

Pay

Hourly range: $45.31–$67.01 (actual rate dependent upon experience).

Benefits