Ambulatory RN Care Manager

Intermountain Health; Las Vegas (NV); Hybrid; USD 86,000 - 129,000; Full time

Benefits offered by this job

Hybrid Work

Benefits Package

Job summary

Nevada Central Office is seeking an RN Ambulatory Care Manager I to deliver comprehensive ambulatory care management services for identified patients. The role involves screenings, assessments, and developing patient-centered care plans across clinics, transitions of care, and post-acute settings.

The position is full-time in a hybrid/office environment, with days Monday–Friday and no weekends. Strong collaboration, education, and data analysis are key components of this role within

Qualifications

• Current RN license in state of practice.
• BSN within four years of hire/promotion.
• Clinical nursing experience in chronic disease management.
• Understanding of disease management and barriers to care.
• Proficiency with basic computer skills and Microsoft Office.
• Caregivers with home/community visits must have BLS, driver’s license, insurance, reliable transportation.

Responsibilities

• Identify patients for proactive interventions and assess needs to create individualized care plans.
• Develop, maintain, and monitor NCQA-aligned care plans and coordinate services.
• Support patient self-management through motivational interviewing.
• Educate healthcare team and patients about case management and referrals.
• Collaborate with multidisciplinary team to ensure timely care.
• Drive transitions of care and avoid duplicative services.
• Facilitate advanced care planning and participate in patient/family conferences.
• Analyze data to identify trends in post-acute stays and readmissions.
• Promote Intermountain Health mission and values.

Skills

Care management

Chronic disease management

Interdisciplinary collaboration

Patient education

Motivational interviewing

Communication

Education

BSN

Tools

Microsoft Office

Job description

Hybrid Work

Nevada Central Office

Full time

R183229

Job Description:

The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves conducting care management screenings, assessments, and evaluations. The manager develops and implements patient-centered care plans with shared goals and appropriate interventions. Collaborating effectively with patients, families/caregivers, healthcare providers, payers, community-based providers, and other involved parties ensures efficient, effective, and patient-centered care management services. The role operates across various settings, including transitions of care, clinics, communities, and post-acute care environments, and supports proactive care for at-risk patients.

Job Specifics

• Benefits Eligible: Yes

• FTE: Full time

• Shift: Days, Monday-Friday; No weekends

Essential Functions

• Patient Identification and Assessment : Identifies patients for proactive interventions using specific screening criteria, medical record review, payor models, medical risk scores, or referrals. Assesses patients' medical, functional, and social conditions per department policy/guidelines to develop individualized care plans and connect them with community resources. Assesses patients per NCQA standards as appropriate.

• Care Plan Management : Develops, maintains, and monitors patient care plans consistent with NCQA and department policies/guidelines, ensuring adherence to medical plans and focusing on prevention measures. Coordinates internal and external services for SDoH needs and care in the community. Evaluates the effectiveness of the patient’s care plan and outcomes. Modifies the plan of care or specific interventions, as appropriate.

• Patient Support : Supports patient self-management and behavior change using motivational interviewing and coaching techniques. Assesses patient readiness and capacity for change and confidence in self-care.

• Education and Advocacy : Educates healthcare team members about case management processes, appropriate referrals, and advocate for patient rights. Educates patients about their medical/behavioral health conditions and self-management.

• Multidisciplinary Collaboration : Collaborates with physicians and other healthcare team members on the patient’s behalf to ensure the patient receives quality and timely care and resolves any delays or issues. Participates in rounds or case conferences when necessary. Utilizes team-based care approach referring and consulting with social work, nutrition, pharmacy, rehabilitation, behavioral health, etc. resources as appropriate.

• Relationship Building : Develops and maintains collaborative partnerships with hospital care management, post-acute providers, and other care managers to ensure seamless transitions and continuity of care. Avoids duplicative care management services/programs.

• Process Improvement : Actively participates in system and regional initiatives to improve transitions of care and avoid duplicative services.

• Advanced Care Planning: Facilitates advanced care planning and engages in patient and family care conferences as appropriate.

• Data Analysis : Conducts root cause analysis of extended post-acute stays, inappropriate utilization, readmissions, and tracks key data elements or metrics. Identifies, analyzes, and monitors industry, regulatory, technology, and market-based trends that impact ambulatory and post-acute services.

• Mission and Values Driven: Promotes the mission, vision, and values of Intermountain Health, and abide by service behavior standards.

Minimum Qualifications

• Current Registered Nurse (RN) license in state of practice.

• Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required). RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion.

• Demonstrated clinical nursing experience in chronic disease management, and familiarity with chronic disease terminology and processes.

• Demonstrated understanding of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation.

• Proficiency in basic computer skills and Microsoft Office software.

• Caregivers whose duties require them to conduct home or community visits must maintain current BLS certification, have a current driver's license, current auto insurance, an acceptable driving record and reliable transportation.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN) from an accredited institution.

• Care Management Certification

• Demonstrated experience in case management, utilization review, or discharge planning.

Physical Requirements

• Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.

• Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.

• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc.

• Expected to lift and utilize full range of movement to transfer patients. Will also bend to retrieve, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.

• Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc.)

• May be expected to stand in a stationary position for an extended period of time.

• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$41.20 - $62.17

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.

Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.

To find out more about us, head to our career site here (https://intermountainhealthcare.org/careers/?utm_source=Workday&utm_medium=Redirect&utm_campaign=CareerHome_workday) .

Intermountain Health's PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional