RN Care Management & Sales Consultant

About the role

Select Health is seeking a Commercial Care Management Sales Consultant to partner with various departments and stakeholders. This role involves building and maintaining relationships with employers, brokers, providers, and members, leading special projects, and serving as a care management subject matter expert.

Responsibilities

• Communicate and collaborate with new and existing employer groups, brokers, providers, partners, networks, and internal departments to demonstrate the value of SelectHealth's Utilization and Care Management services.
• Create and present compelling reports and content that resonate with target audiences, focusing on member engagement, care management program progress, and outcomes.
• Provide data, expertise, and clinical reviews for proposals, projects, presentations, and request for information, collaborating with Health Connections Leaders.
• Maintain a positive impression by providing an extraordinary customer and member experience through clear, concise, and accurate communication.
• Demonstrate a strong clinical understanding of Care and Disease Management programs, functions, and processes, including documentation in the care management operating system.
• Lead process improvement projects related to Care Management for the Commercial and Self-Funded line of business, monitoring and evaluating clinical and claims data.
• Identify members who require additional assistance and refer them to care management services, and perform Care Management activities following established policies and procedures.
• Collaborate with Select Health members, their families, caregivers, and a multidisciplinary care team to assess, plan, facilitate, navigate, coordinate, evaluate, and advocate for comprehensive medical, behavioral, and social needs.
• Follow established models of care or care management programs to develop and maintain a care plan that addresses the member's individual needs and goals.

Requirements

• Bachelor's degree in nursing (BSN) from an accredited institution.
• Current RN (Nurse) compact license to practice in all states that are part of the compact and Select Health Region.
• Current and in good standing driver's license with means for transportation to and from members' residences, providers, or sites of care.
• Five years of clinical practice experience, including acute care, quality assurance, home care, community health, or occupational health experience.
• Two years of care management experience and demonstrable understanding of health plan-related care management regulatory standards and/or knowledge of government programs (e.g., Medicare, Medicaid).
• Excellent written and verbal communication, customer service, and conflict resolution skills.
• Intermediate hardware skills, ability to customize computer settings, use multiple monitors, and perform independent troubleshooting of internet and applications.
• Intermediate computer software skills, including proficiency in PowerPoint, Excel, Teams (chat, whiteboard, task tracking), and Outlook.

Qualifications

• Commission for Case Manager Certification (CCMC)-Case Management Certification-CCM or American Case Management Association-ACMA- Accredited Case Manager-ACM Certification.
• Experience working with third-party payers.
• Ability to work independently and be flexible in a rapidly changing environment.
• Experience working successfully in a remote environment or using advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook.
• Ability to work independently, take initiative, have a cheerful outlook, and be flexible in a rapidly changing environment.

Physical Requirements

• Ongoing need to see and read information, documents, monitors, identify equipment and supplies, and assess customer needs.
• Frequent interactions requiring verbal communication and hearing and understanding spoken information, needs, and issues quickly and accurately.
• Manual dexterity for manipulating complex and delicate equipment with precision and accuracy, including frequent computer use for typing and accessing needed information.
• May be expected to sit or stand in a stationary position for a long time.

Benefits

We offer a comprehensive benefits package that includes a wide range of programs designed to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our benefits package here.