RN Care Manager – I

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

📋 Description

• Collaborate with Select Health members, their families, caregivers, and multidisciplinary care teams through assessment, planning, facilitation, navigation, coordination, evaluation, and advocacy.

• Enhance the health of patients with chronic conditions or complex needs.

• Provide education to patients and caregivers to assist them in managing healthcare requirements.

• Facilitate communication and coordinate services among members, families, providers, healthcare teams, payers, Sales Team, and Employer Groups.

• Tackle barriers and promote the optimal allocation of resources while balancing clinical quality and cost management.

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

• Identify members requiring complex assistance and enroll them in longitudinal care management services.

• Utilize established care models and program policies to assess, create, and maintain care plans.

• Ensure care plans are evidence-based and align with referral goals, payer contracts, and established care processes.

• Maintain case records and document events and progress in accordance with NCQA, CMS, and State EQRO requirements.

• Contact patients at designated intervals to assess progress towards goals.

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

⛳️ Requirements

• Active license to practice as a Registered Nurse in the state of residence.

• Compact state license must be obtained within 60 days of hire if the primary state of residence is part of the Nurse Licensure Compact.

• Single-state license for assigned non-compact states required within 60 days of hire, as applicable.

• Proven experience and expertise in clinical nursing.

• At least 1 year of experience in care management/navigation or a closely related field, including utilization management, discharge planning, managed care, health promotion, health coaching, behavioral health, quality, or patient education.

• Strong written and verbal communication skills along with effective conflict resolution abilities.

• Intermediate proficiency in computer software and hardware.

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

• RNs hired or promoted into this role must possess or obtain a BSN within three years of hire or promotion.

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

• Preferred: Case Management Certification.

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

• Preferred: Experience working with third-party payers.

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

• Ability to work independently and adapt in a rapidly changing environment.

• Demonstrated excellent written and verbal communication skills.

• Ongoing ability to see and read information, documents, monitors, equipment, and supplies.

• Ability to verbally communicate, hear, and quickly and accurately understand spoken information, needs, and issues.

• Manual dexterity to operate complex and delicate equipment.

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

🏝️ Benefits

• Comprehensive benefits package that supports programs for living a healthy, happy, secure, connected, and engaged life.

• Provision of company equipment and remote work support, as outlined in remote work expectations.