Health Plan Registered Nurse RN Case Manager
Company: Banner Health
Posted on: October 12, 2018
Health Plan Registered Nurse RN Case Manager - The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. Our team has come together with the common goal: Make health care easier, so life can be better. The future of health care starts here. If you're ready to change lives, we want to hear from you. Apply today. As a Health Plan RN Case Manager, you would be working within a multifaceted healthcare industry and providing navigation assistance to members/caregivers and providers in accordance with Medicare and Medicaid regulatory compliance standards. The RN Case Manager ensures that High Need/High Cost members receive integrated physical and behavioral health care, facilitates care coordination of D-SNP members, maintains appropriate documentation, attends interdisciplinary meetings and collaborates with UM, BH, and MCH Case Managers to meet the comprehensive needs of the members. Schedule: Full time, Day shift: 8:30AM-5:00PM Location: Banner Corporate Mesa or Banner Health Plans- Elvira, Tucson Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life. If you are a New Graduate Nurse with less than 12 months of experience, please apply to our New Nurse Experience openings. - About University Physicians Health PlansThe University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care. About Banner HealthBanner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee. - Job SummaryThis position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care. Essential Functions Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice. May supervise other staff. Minimum QualificationsMust possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care.Requires current Registered Nurse (R.N.) license in state worked. For assignments in an acute care setting, Basic Life Support (BLS) certification is also required.Requires a proficiency level typically achieved with 3-5 years clinical experience. Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format. For assignments in an acute care setting, must be able to work flexible hours and take rotating call after hours. Banner Registry and Travel positions require a minimum of one year experience in an acute care hospital and/or home care setting. Experience must include working in an acute care and/or home care setting within the past 12 months as a Case Manager in the specialty area.Preferred QualificationsCCM (Certified Case Manager) preferredAdditional related education and/or experience preferred.
Keywords: Banner Health, Tucson , Health Plan Registered Nurse RN Case Manager, Healthcare , Tucson, Arizona
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