Employee Health Case Manager RN

Presbyterian System Services; Albuquerque (NM); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Educational and career development

Tuition and certification reimburse

Staff safety wearable badge

Night/weekend shift differentials

Malpractice liability insurance

Loan forgiveness program

EPIC electronic charting system

Job summary

Presbyterian Healthcare Services in Albuquerque, NM seeks a skilled Case Manager to assess, plan, implement, coordinate and evaluate care for identified populations.

You will educate providers, screen referrals, advocate for members, and collaborate with health care teams to improve outcomes and cost-effectiveness. Requires associates degree, NM nursing license, and CCM certification preferred.

Qualifications

• Associates degree in Nursing, Business, or Health related field.
• NM nursing license required.
• CPR certification.
• CCM certification or within 3 years of hire.
• Computer knowledge including Windows, word processing and database systems.
• Ability to analyze trends using decision support systems.
• Cost/benefit analysis, negotiation and cost containment.
• Referral coordination to community and public/private resources.

Responsibilities

• Identifies cases appropriate for case management.
• Educates providers and other departments on case management services.
• Screens new referrals for case management appropriateness.
• Conducts in-depth assessments across psychosocial, physical, medical, environmental and financial parameters.
• Advocates for members in caseload and develops care plans.
• Coordinates care with physicians and care providers to optimize outcomes and costs.

Skills

CPR certification

Education

Associates degree in Nursing, Business, or Health related field

NM nursing license

CCM certification

Tools

Windows

Word processing

Database systems

Job description

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $0.00 Maximum Offer $0.00 Summary: Independently facilitates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes How you grow, learn and thrive matters here.

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through theNewMexicoHigherEducationDepartment
• EPIC electronic charting system

Type of Opportunity: Full time FTE: 1.00 Job Exempt: Yes Work Shift: Days (United States of America)

• Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
• Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload.
• Formulates, implements, coordinates, monitors,, and evaluates strategies for patients and families collaboratively with member, families and health care team. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
• Actively participates in the development of clinical guidelines and pathways and incorporates processes into the role of case managers.
• Educates providers on health management strategies which can reduce need for one-on-one case management services. Educate physicians, nurses, ancillary support staff, patients, and families regarding case management role.
• Facilitates a team approach to the coordination and cost effective delivery to quality care and services across the continuum. Collaborates with physicians, care providers, and ancillary support services to address care management issues for specific patients and disease processes.
• Refers patients to appropriate inpatient, outpatient, and community resources.
• Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and patient satisfaction. Collects clinical path variance data that indicate potential areas for improvement of case and services provided within the system. Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
• Complies with Case management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.
• Performs other functions as required.

Qualifications: Associates degree in Nursing, Business, or Health related field required. NM nursing license required. CPR certification. Five years of experience in clinical nursing with a minimum of three to five in case management, utilization management, quality assurance, home care, community health, or occupational health. CCM certification or within 3 years of hire. Computer knowledge to include Windows, word processing and database systems. Ability to analyze trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, & cost containment. Knowledge in referral coordination to community & private/public resources We're all about well-being, starting with yours.

Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more. Learn more about our employee benefits.

About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED.

PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.