SWHR CIN Care Manager Registered Nurse (RN) - Full Time - Monday-Friday - 8:00am-5:00pm - Remote Position at Southwestern Health Resources CIN in Pittston, Pennsylvania

Job Description:

Care Manager Registered Nurse (RN) - Remote Position

Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for qualified Care Manager RN's like you to join our Texas Health family.

Position Highlights

• Work location: Denton, Lewisville, and Flower Mound, TX area • Work environment: Care Coordination Department • Work hours: Full-Time, 40 hours week, Monday-Friday, 8:00 A.M. - 5:00 P.M. • Travel Required - 25% (approximate) • Salary range: $36.09 - $51.04 per hour (based on relevant experience)

As a clinically integrated network with nearly 5,000 physicians and advanced practice providers, Southwestern Heath Resources (SWHR) connects physicians and insights to outcomes identifying barriers to better population health management. SWHR unites providers, specialist, clinicians, and care coordinators to build a better healthcare system for all.

Qualifications

• Associate's Degree in Nursing required. • Bachelor's Degree in Nursing preferred. • 3 years of Managed care and/or Clinical care experience required. • Case Management experience required. • Disease Management experience required. • Utilization Management and Pre-authorization experience preferred. • RN - Registered Nurse required upon hire. • CCM - Certified Case Manager or equal approved certification or must obtain within 18 months of employment or transfer into position 18 Months required. • Strong analytical and organizational skills. • Working knowledge and ability to apply professional standards of practice in work environment. • Knowledge of specific regulatory, managed care requirements preferred.

Position Responsibilities SWHR Care Manager RN's will s upport the Collaborative Care Management Model: Collaborating with physicians, social workers, pharmacists, and other professional staff in order to improve overall patient outcomes.

In addition to the required qualifications, a successful CST will:

• Responsible for meeting production goals on an ongoing basis as defined by leadership in order to meet business needs. • Demonstrates effective caseload assignment through complex case management
Demonstrates an understanding of funding resources, services, and clinical standards and outcomes. • Demonstrates knowledge of case management standards of practice and processes including identification, assessment, planning, interventions, and evaluation. • Demonstrates the ability to participate effectively in interdisciplinary team conferences specific to complex cases. • Accountable for on-going compliance with the policies and procedures. This includes the standards of accrediting bodies and the regulations of state and local governing agencies (i.e. CMS and Nursing Practice Act) • Demonstrate strong commitment to client service and delivers quality work product. • Use interpersonal/communication skills and strategies with individuals to achieve: (a) desirable/acceptable outcomes/responses (b) perceptions of satisfaction or acceptance of those involved. • Perform procedures required by the assignment: (a) safely, without causing harm (b) effectively, achieving the intended outcome/result (c) efficiently, using the fewest possible resources (d) legally, within the scope of practice/policy. • Establish and/or revise priorities based on: (a) urgency of the patient or organizations need (b) resource availability (c) predetermined schedules (d) other department/personnel expectations. • Ensure activities are prioritized to achieve desired results. • Seeks direction when lack of clarity exists to maximize performance. • Meets team goals by ensuring individual actions are aligned with the team needs. • Demonstrates knowledge of NCQA and HEDIS Standards. • Establish and maintain effective relationships with customers and gain their trust and respect. • Provide clinical oversight for LVNs or SWs as needed within RN Nursing Guidelines (may include but not limited to medication reconciliation). • Additional duties as assigned to meet business needs.

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