Job Description:

Scope

Includes oversight of a specialized program. May include team leadership.

Job Essentials

Program Integrity: Responsible for development, documentation and implementation of a SNP for SelectHealth's dually eligible enrollees. Is involved in enrollee engagement efforts, care coordination strategies, identification of system issues pertaining to quality of care, clinical outcomes and ongoing evaluation of program effectiveness.
Identification: Identifies eligible enrollees using risk assessment outcomes and stratification tools.
Assessment and Opportunities Identification: Reviews medical records and other relevant referral information to assess the individual's needs and opportunities for improvement through program participation.
Planning: Ensures a multidisciplinary, evidence-based plan of care is developed for all enrollees receiving care management services. The plan includes goals, interventions and determines the type of services and resources available to address the established goals or desired outcomes.
Implementation and Coordination: Supports and educates the enrollee, family and/or caregiver through enactment of the plan. Facilitates collaboration and communication among all involved parties and acts as a resource for members of the interdisciplinary care team.
Evaluation of the Care Plan: Documents and communicates progress toward goal achievement, the enrollee's status and associated outcomes.
Quality Improvement: Initiates and/or participates in data management and quality improvement activities relevant to the program/department.
Professional: Consistently demonstrates an attitude of superior service for internal and external customers. Participates on a variety of forums (i.e., committees, workgroups) to improve the SNP program and/or department processes. Ensures compliance with all program, department, company and regulatory policies, procedures and standards of practice. Maintains a knowledge-base of current clinical technology/methodology.

Job Specifics

• Benefits Eligible: Yes; Medical, Dental, Vision, Education Assistance.for more details
• Shift Details: Full time- 40hrs/wk - Exempt.
• Department/Unit: Care Mgmt - Medicare
• Additional Details: This position will work remote with daily to 2-3 times per week at home visits in Weber/Davis County. Approximately once a month office visit.

Minimum Qualifications

• Bachelor's degree in Nursing (BSN) from an accredited institution (degree will be verified).
• RN with a current license in the State of Utah.
• Five years of clinical nursing practice that may include quality assurance, home care, community health or occupational health experience with a minimum of one year of care management or utilization management experience.
• Demonstrated ability to exercise critical thinking, data management and analytical skills.
• Strong written and verbal communication skills.
• Intermediate knowledge of word processing and ability to produce reports.

Preferred Qualifications

• Certification in Case Management (CCM).
• Knowledge of government programs (i.e., Medicare; Medicaid).
• Health insurance product knowledge.
• Experience working with third-party payers.
• Demonstrated leadership skills.
• The ability to work independently, be self-motivated, demonstrate a positive attitude and exercise flexibility in a rapidly changing work environment.

Physical Requirements:

Ongoing need for employee to see and read information, assess member needs, and view computer monitors.
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Frequent interactions with providers, members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues accurately
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Manual dexterity of hands and fingers, this includes frequent computer use and typing for documenting member care, accessing needed information, etc.

Anticipated job posting close date:

Location:

Work City:

Work State:

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

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.

Learn more about our comprehensive benefits packages for our, and for our ; and our commitment to.

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.