RN Care Manager I

Intermountain Health; Annapolis (MD); On-site; USD 56,000 - 85,000; Full time

Benefits offered by this job

PEAK program

Job summary

Intermountain Health seeks a Nurse Care Manager to collaborate with physicians and a multidisciplinary team to improve outcomes for members with chronic or complex needs.

You will educate patients and families, coordinate services, and develop individualized care plans aligned with benefit policies while ensuring regulatory compliance and cost efficiency.

Qualifications

• Current RN license in state of residence.
• Within 60 days, obtain compact state license if PSOR is part of the Nurse Licensure Compact.
• BSN within 3 years for RNs hired or promoted into this role.
• Experience in care management/navigation or related field required.
• Strong written and verbal communication skills.
• Able to customize computer settings and troubleshoot internet/applications.

Responsibilities

• Collaborate with physicians and care team to improve health of patients with chronic or complex needs.
• Educate patients and caregivers to help manage health care needs.
• Coordinate services, address barriers, and promote optimal resource use.
• Develop, document, and implement individualized care plans.
• Maintain records per NCQA, CMS and state EQRO standards.
• Communicate with member/family and care team through interdisciplinary meetings.

Skills

Care Management

Care Planning

Clinical Nursing

Independent Working

Motivational Interviewing

Time Management

Problem Solving

Psychosocial Evaluations

SMART Goals

Verbal Communication

Education

RN license

BSN preferred

Tools

Microsoft Teams

Outlook

Advanced Microsoft Suite

Job description

Job Description: Select Health is a community health plan serving more than 1 million members. Select Health’s line of businesses include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and self-funded Commercial Employer plans. The Care Manager works with Select Health members, their family, caregivers, and a multi-disciplinary care team in a collaborative process of assessment, planning, facilitation, navigation, coordination, evaluation and advocacy in order for member to access benefits, resources, and services to meet comprehensive medical, behavioral, and social needs of members while promoting self-management, quality, and cost-effective outcomes.

Essential Functions

The nurse care manager works collaboratively with physicians and other members of the health care team to improve the health of patients with chronic conditions or complex needs. The position educates patients and caregivers to help them manage their health care needs. The incumbent facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management. This position is responsible for developing, documenting and implementing care plans, which will provide the appropriate resources to address social, physical, mental, emotional, spiritual, and supportive needs. Identifies members unable to adhere to a medical plan or members that require complex additional assistance and enrolls and follows these members in longitudinal care management services. Follows the applicable established model of care or care management program policies and procedures to assess, establish and maintain a plan of care which incorporates the member's individualized needs and goals within the benefit plan throughout the care management process. Ensures the plan is evidence based and consistent with goals and objectives of referral, payer contract, or established care processes. Maintains records by reviewing case notes, logging events and progress according to applicable regulatory requirements such as NCQA, CMS and State EQRO standards. Coordinates and facilitates communication among the member/family/representative, members of the healthcare team, and other relevant parties (e.g., other payers, Sales Team, Employer Groups, etc.) through interdisciplinary team meetings or other coordinated communication. Contacts patient at prescribed intervals and as necessary to determine if the goals are being achieved or if they continue to be appropriate and/or realistic. Determines variances and refers patients to a more comprehensive level of care if indicated.

Skills

• Care Management
• Care Planning
• Clinical Nursing
• Independent and autonomous
• Motivational Interviewing
• Prioritization & time management
• Problem Solving
• Psychosocial evaluations
• SMART Goals
• Verbal and Written Communication

Qualifications

Minimum Qualifications: Current license to practice as a Registered Nurse in the state of residence. If primary state of residence (PSOR) is part of the Nurse Licensure Compact, you must have a compact state license within 60 days of hire. If your work assignment is in a non-compact state, you must obtain a single state license per state(s) assigned within 60 days of hire. If PSOR is in a non-compact state, you will need a license in the state you reside, and within 60 days of hire you must obtain a Utah license, and other state licenses dependent on your work assignment.

• Demonstrated experience and expertise working in clinical nursing
• Minimum 1-year experience in care management/navigation or closely related field including Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, quality, or patient educator job role.
• Strong written, verbal communication and conflict resolution skills
• Intermediate computer software and hardware skills, ability to customize computer settings and use multiple monitors and capable of independent troubleshooting internet and applications.
• RNs hired or promoted into this role need to have or obtain a BSN within three years of hire or promotion.

Preferred Qualifications

• Bachelor's degree in nursing (BSN) from an accredited institution (degree will be verified).
• Case Management Certification.
• Three years of experience and expertise working in clinical nursing in an ambulatory care setting, community health or home care.
• Experience working with third party payers.
• Ability to work independently and be flexible in a rapidly changing environment.
• Demonstrated excellent written and verbal communication skills.
• Experience working successfully in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook; Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.

Physical Requirements

Ongoing need for employees to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. Frequent interactions with colleagues and providers require employees to verbally communicate and hear and understand spoken information, needs, and issues quickly and accurately. Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc. May be expected to sit or stand in a stationary position for a long time.

Location: SelectHealth - Murray Work City: Murray Work State: Utah 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.

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 skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment.

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

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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.

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Thanks for your interest in continuing your career with our team!