This position plans and provides managerial and/or clinical, behavioral, counselling support to members, staff and leadership within the department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains a depth and breadth of clinical competency and/or managed care knowledge to assess outcomes related to delivery of Care Management services.
Provides and/or facilitates care management and/or other related activities and serves as a resource to other staff members. Promotes interdisciplinary patient care planning and supports Care Model. Assists staff in the management of individual members across the health care continuum (longitudinal support) to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Hires, trains, conducts performance evaluations, and directs the workflow for the staff. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.
Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities within the department. Works with staff to make necessary changes. May analyze data and healthcare trends to gain efficiencies and improve patient outcomes.
Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
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.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
Oversees and is responsible for the quality of RN assessments. Assists with payer audit process surrounding NCQA, URAC, or any other regulatory agency requirements.
Bachelors Degree in Nursing with three years of experience directly related to care management in health plan/mgmt./quality.
Requires current Registered Nurse (R.N.) license in state worked.
Requires extensive knowledge in the areas of care management and utilization management. Must have a working knowledge of ambulatory operations, hospital and community resources. Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations. Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers. In BPA (Benefits Plan Administration) setting, requires an understanding of reimbursement methodologies.
Certification with nationally recognized healthcare organization, such as CCM, preferred.
Additional related education and/or experience preferred.
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.