Employee Health Case Manager RN

Presbyterian Healthcare Services

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 the New Mexico Higher Education Department

EPIC electronic charting system

Type of Opportunity: Full time

FTE: 1.00

Job Exempt: Yes

Work Shift: Days (United States of America)

Responsibilities:

*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

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.