Clinical Care Manager RN I (Health Plans) - Remote

Samaritan Health Services; Austin (TX); Remote; USD 65,000 - 85,000; Full time

Job summary

A regional healthcare provider is looking for a remote nurse to assess and manage care options. Candidates must have a current Oregon RN license and one year of clinical nursing experience. This role emphasizes communication and critical thinking skills for effective patient care management. The position is available to candidates in various states, including Texas, and involves evaluating patients' health needs according to Medicare and Medicaid policies.

Qualifications

• One year clinical nursing experience is required.
• Experience in health care delivery systems and/or managed care patients.
• Knowledge of Medicare and Medicaid rules and regulations.

Responsibilities

• Assess, plan, implement, coordinate, monitor, and evaluate care options.
• Provide care management interventions across transitions of care.
• Work with cases that have a low to moderate level of service intensity.

Skills

Effective written and verbal communication skills

Critical Thinking

Confidentiality knowledge (HIPAA)

Case management

Education

Current unencumbered Oregon RN License

BSN preferred

Tools

MS Office

EPIC

Clinical Care Advanced

Job description

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

Candidates residing out of state will need to be able to work Pacific Time Zone hours.

This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

JOB SUMMARY/PURPOSE

• Assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs. Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible. Provides care management interventions and seamless support across transitions of care. Works with cases that have a low to moderate level of service intensity.

EXPERIENCE/EDUCATION/QUALIFICATIONS

• Current unencumbered Oregon RN License required. BSN preferred.
• One (1) year clinical nursing experience required.
• Experience or training in the following required:
  • Health care delivery systems and/or managed care patients.
  • Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
• Experience in the following strongly preferred:
  • Case management.
  • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

KNOWLEDGE/SKILLS/ABILITIES

• Communication - Effective written and verbal communication skills provided to members, providers and organization staff. Able to tactfully discuss issues, and listen to and understand complex information/situations. Ability to apply motivational interview techniques when working with members. Proactively resolve conflicts in positive and constructive manner.
• Confidentiality - Knowledge of State and Federal (HIPAA) laws pertaining to confidentiality of protected health information. Ability to comply with laws and maintain confidentiality of patient information.
• Critical Thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions in a member centric manner.
• Social Perceptiveness - Ability to work with a diverse population from pediatrics to geriatrics. Basic understanding of age-related differences in caring for and/or communicating with members and caregivers. Possess personal sensitivity to the needs and experiences of others and a non-judgmental attitude towards persons of differing standards, values, lifestyles, and ages.
• Knowledge of Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Ability to appropriately apply evidence based clinical practice and criteria to authorization requests.

PHYSICAL DEMANDS

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
  • Rarely (1-10% of the time): CLIMB - STAIRS, LIFT (Floor to Waist: 0-36) 0-20 Lbs, LIFT (Knee to chest: 24-54) 0-20 Lbs, LIFT (Waist to Eye: up to 54) 0-20 Lbs, CARRY 1-handed, 0-20 pounds, BEND FORWARD at waist, KNEEL (on knees), STAND, WALK – LEVEL SURFACE, ROTATE TRUNK Standing, REACH - Upward, PUSH (0-20 pounds force), PULL (0-20 pounds force), SIT, CARRY 2-handed, 0-20 pounds, ROTATE TRUNK Sitting, REACH - Forward, MANUAL DEXTERITY Hands/wrists, FINGER DEXTERITY, PINCH Fingers, GRASP Hand/Fist