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Complex Care Manager RN - Care Transformation and Innovation, Southwestern Health Resources (SWHR) at Southwestern Health Resources CIN in Pittston, Pennsylvania

Posted in General Business 30+ days ago.

Type: Full-Time

Job Description:

Complex Care Manager RN - Care Transformation and Innovation

Care Transformation and Innovation Department is looking for top skilled Complex Care Manager RN. Is that you?

Work location: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work environment: Care Transformation and Innovation Department.

Please note: The Complex Care Manager RN will be an employee of Southwestern Health Resources (SWHR). SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW).

Work hours:

  • Full-time, 40 hours per week.
  • Monday - Friday, Day shift.
  • This is a Hybrid position, requiring onsite workdays during the week, based on department business needs.
  • Travel required within Dallas/Fort Worth Metroplex and surrounding areas/cities, especially within counties of Tarrant, Denton, Parker, Wise, to Provider and Member locations, based on department business needs. Mileage related to work will be reimbursed based on the department mileage reimbursement guidelines.
  • In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.
Organization Highlights

Southwestern Health Resources (SWHR) is a patient-centered, clinically integrated network of 29 hospital locations and more than 6,900 physicians and clinicians caring for more than 730,000 patients across 16 counties in North Texas. Blending the strengths of Texas Health Resources and the University of Texas Southwestern Medical Center, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. SWHR is the parent of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan providing care to over 12,000 members.

At SWHR, we believe healthcare can be more integrated, accessible and affordable for all. Our purpose: to build a better way to care, together. Our promise: to simplify and empower care, for good.


  • Associate's Degree in Nursing required.
  • Bachelor's Degree in Nursing preferred.
  • Master's Degree in Nursing, Health Administration, MBA, Public Health or other healthcare related field preferred.

  • Require 3 years of related clinical experience or equivalent, preferably in Telephonic Care Management, Case or Disease Management, Home Care or Hospice.
  • Prefer 2 years of experience in Acute or Chronic institutional care setting.
  • Highly prefer experience in Special Needs Plan (SNP) Care Management, Complex Care Management (CCM), Transitions of Care (TOC) Management, National Committee for Quality Assurance (NCQA) including the Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare & Medicaid Services (CMS) standards and knowledge of pertinent guidelines.
Licenses and Certifications

  • Current and active Registered Nurse (RN) License in good standing upon hire required.
  • Certified Case Manager (CCM) Certification within 18 months of hire date as a condition of continuing employment required.
  • Certified Hospice and Palliative Care Nurse (CHPCN) Certification upon hire preferred.
  • Oncology Certified Nurse (OCN) upon hire preferred.
  • Stroke Certified Registered Nurse (SCRN) upon hire preferred.
Skills & Abilities

  • Professional demeanor. Self-directed. Ability to work as a member of a team.
  • Knowledge and skill in chronic disease management.
  • Excellent verbal and written communication (including documentation) skills.
  • Strong organizational and time-management.
  • Exceptional customer service skills and understanding of patient and family care concepts.
  • Ability to monitor, assess and record patient progress against a plan of care.
  • Ability to facilitate patient access to community resources.
  • Ability to work collaboratively with providers, vendor partners and external organizations.
  • Ability to assess, adapt, and calmly respond to changing and crisis environment.
  • Ability to maintain confidentiality with all aspects of patient information in accordance with all applicable policies and regulations.
Position Responsibilities

The RN Complex Care Manager, as part of an integrated, multidisciplinary care team, is responsible for assisting patients who are diagnosed with complex illnesses, recovering from a traumatic clinical event, managing multiple clinical co-morbidities, or facing end of life care options. The RN Complex Care Manager works in collaboration with other physicians and other members of the health care team to meet the patient's needs. The RN Complex Care Manager leads the development and ongoing management of a comprehensive, individualized care plan with each patient. The care plan helps the patient and their family fully understand their clinical condition, manage symptoms associated with their condition, understand, and navigate treatment alternatives, and address non-clinical issues that impact quality of life and outcomes.

Position Functions

  • Functions as a clinician, case manager and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. Researches, evaluates, and recommends resources to meet medical and non-medical needs of patients and families.
  • Utilizes clinical expertise and understanding of care management, Medicare regulations, and contributes to the goals of cost containment and quality care and provides safe and appropriate transitions of care. Collaborates, refers, and communicates across all programs to ensure appropriate coordination of services.
  • Works collaboratively and maintains active communication with physicians, nursing, and other members of the interdisciplinary team to effect timely and appropriate patient management.
  • Serves as an advocate, placing the needs of patients and their families first. Delivering compassionate care that is whole person care: body, mind, and spirit. Supports shared decision making and encourages patient adherence to their care plans. Promote patient and family responsibility and self-management.
  • Conducts EMR reviews and patient interviews via face-to-face and/or telephonic engagements to assess, identify, and close clinical and non-clinical gaps in patient care. Evaluate changes in patient-reported symptoms and conduct additional triage and screening to determine next steps.
  • Assists with the collection, analysis and benchmarking of utilization, process, and outcomes metrics. Analyzes productivity. Measure outcomes and effectiveness of care management including clinical, financial, quality of life and patient/family satisfaction. Identifies opportunities for continuous improvement. Participates and promotes performance improvement projects.
Why Southwestern Health Resources

As a Southwestern Health Resources employee, you'll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

  • Gain a sense of accomplishment by contributing to a teamwork environment.
  • Positively impact patients' quality of life.
  • Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
  • Enjoy opportunities for growth.
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at


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