This position will be responsible to manage the complex chronic and rising risk members in the populations where care management is delegated to do so. He/she will be the main point of contact for members and providers across care settings. The aim is to better manage patients in the ambulatory setting by following patients deemed as or of becoming heavy users of care due to multiple chronic illnesses, high ED utilization, or a recent discharge from a skilled nursing facility, etc. The RN engages the appropriate resources within the multidisciplinary team to achieve optimal results for the patient, family, and care givers. This position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs.
Manages individual patients across the health care continuum (longitudinal support) to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Provides disease management or referral to disease management support in ancillary areas (i.e. pharmacy, social work, palliative, etc.)
Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient care plan. Effectively communicates the plan across the continuum of care. Ensures care plan consistency across providers.
Acts in a leadership function with process improvement activities for populations of patients. Provides patient monitoring, education, and supports patient care plan adherence.
Promotes a more active and informed role in patient self-care; navigates patients identified as high-risk across the continuum, longitudinally.
Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
Educates internal members of the health care team on care management and managed care concepts. Facilitates integration of concepts into daily practice.
Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care.
Requires current Registered Nurse (R.N.) license in state worked. For assignments in an acute care setting, Basic Life Support (BLS) certification is also required.
3 years of experience directly related to Care Management in a Health Plan, Health Management, or Quality.
Certification with nationally recognized healthcare organization, such as CCM, preferred.
Additional related education and/or experience preferred.
Internal Number: 250218
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.