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Case Management RN Specialist Must Live near Fresno, CA

Company: Tenet
Location: Fresno
Posted on: October 12, 2019

Job Description:

Asa part of the Tenet and Catholic Health Initiatives family, Conifer Healthbrings 30 years of healthcare industry expertise to clients in more than 135local regions nationwide. We help our clients strengthen their financial andclinical performance, serve their communities and succeed at the business ofhealthcare. Conifer Health helps organizations transition from volume tovalue-based care, enhance the consumer and patient healthcare experience andimprove quality, cost and access to healthcare. Are you ready to be part of oursolutions? Welcome to the company thatgives you the resources and incentives to redefine healthcare services, with acompetitive benefits package and leadership to take your career to the nextstep! JOB SUMMARY The Specialist CaseManager RN, under the direction of the Supervisor or Manager of Case Managementprovides direction, identifies health and psychosocial issues of a selectmember population and assesses, plans, implements, coordinates monitors andevaluates services and outcomes to ensure maximized health of the member.Assumes a leadership role within the interdisciplinary care team to achieveoptimal clinical and resource outcomes. ESSENTIAL DUTIES ANDRESPONSIBILITIESInclude the following.Others may be assigned.

  • Identifiesissues relating to members' physical and mental well-being that affects healthstatus and works in collaboration with both the member and provider todetermine appropriate care for case management services.
  • Incollaboration with the member and PCP completes a comprehensive assessment anddevelops a care plan assessing short-term and long-term needs.
  • Actsas a leader during interdisciplinary care team conferences to achieve optimalclinical and resource outcomes.
  • Interactscontinuously with member, family, physician(s) and other providers utilizingclinical knowledge and expertise to determine medical history and currentstatus. Assess the options for care including use of benefits and communityresources to update the care plan.
  • Maintainsand documents initial assessment; designs a care plan that is attainable and inthe appropriate business application program.
  • Actsas a liaison between physician and member to alleviate potential issues thatcan interrupt care.
  • Maintainscase load by identifying cases that are no longer high in intensity or servicesand closes them timely and appropriately.
  • Schedulesor facilitates scheduling appointments and follow-up services; requestsconsultation and diagnostic reports from network specialists; contacts membersto remind them about upcoming appointments and/or missed appointments.
  • Maintainsand promotes confidentiality of patient information and adheres to all HIPAAregulations.
  • Participatesin monthly case studies in the Medical Services Department.
  • Otherduties as assigned.

    Qualifications:
    KNOWLEDGE,SKILLS, ABILITIESToperform this job successfully, an individual must be able to perform eachessential duty satisfactorily. The requirements listed below are representativeof the knowledge, skill and/or ability required. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essentialfunctions.
  • Experience in CM or other managed care environment.
  • Knowledge of disease specific states, clinical and community resources.
  • Strong critical thinking and problem solving skills.
  • Ability to network, advocate, communicate assertively with all customers.
  • Work involving high volume and strict timeframes.
  • Excellent communication skills.
  • Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus.
  • Ability to work in fast paced environment.
  • Works well independently as well as part of a team.
  • Strong commitment to help others.
  • Computer literate; must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus EDUCATION /EXPERIENCEInclude minimumeducation, technical training, and/or experience preferred to perform the job.
  • Minimum Education: LMSW or RN
  • Licensure: Licensure must be current and unrestricted in the appropriate jurisdiction
  • Preferred Education: BA or BS in Nursing, MSW in Social Work
  • Minimum Experience:
  • 2+ years of experience in a clinical acute care position, preferably in home health, physician?s office or public health
  • Preferred Experience:
  • 1 to 3 years? disease management, case management or formal patient education experience;
  • CCM Certification REQUIREDCERTIFICATIONS/LICENSUREInclude minimumcertification required to perform the job.
    • Licensuremust be current and unrestricted in the appropriate jurisdiction PHYSICALDEMANDS Thephysical demands described here are representative of those that must be met byan employee to successfully perform the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.
    • Must be able to work in sitting position, use computer and answer telephone
    • Ability to travel WORK ENVIRONMENT Thework environment characteristics described here are representative of those anemployee encounters while performing the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.
      • Office Work Environment TRAVEL
      • Approximately 5% travel may be required Job: NursingPrimary Location: Fresno, CaliforniaJob Type: Full-timeShift Type: Days

Keywords: Tenet, Fresno , Case Management RN Specialist Must Live near Fresno, CA, Healthcare , Fresno, California

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