RN Care Manager

This is a fully remote position, open to applicants in Utah.

📋 Description

• Collaborate with Select Health members, their families, caregivers, and a multidisciplinary care team.

• Evaluate, plan, facilitate, navigate, coordinate, assess, and advocate for the medical, behavioral, and social needs of members.

• Enhance health outcomes for patients facing chronic conditions or complex needs.

• Provide education to patients and caregivers for effective management of healthcare needs.

• Promote communication and coordinate services effectively.

• Identify barriers and encourage clinical quality alongside cost-effective resource allocation.

• Create, document, and implement personalized care plans that address social, physical, mental, emotional, spiritual, and supportive needs.

• Recognize members requiring additional support and enroll them in ongoing care management services.

• Utilize established care models and program policies to assess, formulate, and uphold care plans.

• Ensure care plans are evidence-based and align with referral objectives, payer agreements, and recognized care processes.

• Keep case records and document events and progress in compliance with NCQA, CMS, and State EQRO standards.

• Facilitate communication among members, families, healthcare teams, payers, Sales Team, Employer Groups, and other pertinent parties.

• Engage with patients at designated intervals to evaluate progress towards their goals.

• Identify variances and refer patients to a more comprehensive level of care when necessary.

⛳️ Requirements

• A valid license to practice as a Registered Nurse in your state of residence.

• If residing in a state that is part of the Nurse Licensure Compact, a compact state license must be secured within 60 days of hiring.

• For non-compact states, a single-state license must be obtained within 60 days of employment.

• Proven experience and proficiency in clinical nursing.

• At least 1 year of experience in care management/navigation or a related field, which includes Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, quality, or roles as a patient educator.

• Excellent written and verbal communication skills, along with strong conflict resolution abilities.

• Intermediate skills in computer software and hardware.

• Capability to customize computer settings, utilize multiple monitors, and independently troubleshoot internet and applications.

• RNs hired or promoted into this position must possess or obtain a BSN within three years of their hiring or promotion.

• Preferred: Bachelor's degree in nursing from an accredited institution.

• Preferred: Certification in Case Management.

• Preferred: Three years of clinical nursing experience in ambulatory care, community health, or home care settings.

• Preferred: Experience working with third-party payers.

• Preferred: Proven success in a remote work environment or proficiency using Advanced Microsoft Suite, including Teams and Outlook.

• Ability to work independently and adapt flexibly in a fast-paced environment.

• Self-motivated with a positive attitude.

• Continuous ability to see and interpret information, documents, monitors, equipment, and supplies.

• Ability to communicate verbally and accurately understand spoken information quickly.

• Manual dexterity to operate complex and delicate equipment.

• Frequent use of a computer for typing and accessing information.

• Ability to remain in a stationary position, either sitting or standing, for extended periods.

🏝️ Benefits

• Comprehensive benefits package that supports wellness programs aimed at fostering a healthy, happy, secure, connected, and engaged lifestyle.

• Company-provided equipment for remote work.

• Clear remote work expectations and support regarding confidentiality, information security, work schedules, conflicts of interest, and the use of company equipment.