Care Manager Nurse

To perform a systematic/situational analysis of the population healthcare needs as related to the Care Management program of IMS Wellness Works. To analyze, & evaluate program needs, and report organization need to the director of Utilization Management.Primary Functions:1.Performs preliminary screening based on referrals to assess eligibility of members for Care Management services when applicable.2.Schedules and performs telephonic calls, and reviews with eligible members, including the review of preventative screening requirements3.Completes outbound telephonic calls to all members with new Health Risk Assessments4.Obtains all pertinent information from the member, and reviews appropriate care plans with members5.Interacts and educates all members and related care givers of appropriate goals and interventions as they related to the Wellness Works or Chronic Condition Management program6.Develops personalized care plans that addresses the health care needs of the enrolled member.7.Coordinates the implementation of services in accordance with the members’ Benefit Plan when needed.8.Refers members to Customer service or to vendor agencies when appropriate to obtain further services and other chronic care services.9.Monitors, and evaluates Care Management services for enrolled members, including periodic direct member telephonic contact10.Documents assessments, care plan goals, progress notes, and evaluations of care in the Deerwalk/Clinical Manager system in accordance with policies and procedures11.Performs periodic review of Moderate Risk and High Risk members as defined by the policies and procedures for Wellness Works12.Maintains current knowledge of healthcare delivery protocols and trends, and all community resources available to the member /family.13.Reviews policies and procedures for Care Management Nurse functions for Wellness Works, and reports needed changes to the Dir. of UM14.Provides Clinical support to Care Management assistant when appropriate15.Reports directly to the Director of UM16.All other duties as assigned.Controls: Independently assesses and renders Care Management functions reflecting appropriate, quality healthcare delivery that best meets patients' needs according to Care Management guidelines.Dimensions: Provides Care Management oversight for 25,000 livesAccountability: Functions directly under the Director of Utilization Management of IMS Managed Care.Physical/Special Demands:•Classified as a light job. No lifting normally included in job responsibilities•Must be able to sit for long periods of time with rest periods•Visual acuity required to use electronic equipment and read written information•Good hearing is required for telephone communications•Cognitive skills are required for reasoning and interpretation of information•Basic computer skills are required, to include Word, Excel, and Access•Legible handwriting required for documentation•Must be able to communicate tactfully, diplomatically and effectivelyRegistered Nurse or LVN with 5 years current clinical experience (e.g. rehabilitation, critical care, trauma center, emergency):•Working knowledge of risk management, liability protection, community services, long term care planning•Excellent oral and written communications•Negotiation and persuasion skills•Strong organizational, time management, problem solving, and responsible decision-making skills•Team player with high degree of creativity and flexibilityHighly desirable:•BSN or equivalent degree in related field•2 years experience in utilization management•Experience in a business or insurance area•Experience in Home Health, Hospice, public health or social services #J-18808-Ljbffr