Registered Nurse RN High Risk Case Manager

Banner Health • Mesa, AZ

4d • Hybrid

About The Position

Innovation and highly trained staff. If you’re looking to leverage your abilities – you belong at Banner Health. The Care Advocate Team provides commercial members with high-risk complex care management support. We collaborate with a multidisciplinary team to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to the Care Advocate Team. As the High-Risk RN Case Manager, you can expect to have a caseload of 50-60 members. You will case manage the commercial population to support their health needs. You will work alongside a LMSW, Pharmacy Team, and Registered Dietitian to ensure a member’s health specific needs are met. This is a full-time salaried role. Expected hours are Monday through Friday, 8AM to 5PM. This role requires telephonic, home visits, and televisit platforms. This role is Hybrid and requires a few in person meetings and home visits as necessary. You must be licensed and reside in the state of AZ for this position. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position will be responsible for case managing the complex chronic and rising risk members in the populations where case management is delegated to do so. This position 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 engaging members identified high risk or at risk for high utilization, cost of care, transition of care and or chronic disease burden. This position engages the appropriate resources within the multidisciplinary team to achieve optimal results for the patient, family, and care givers. The role provides comprehensive care coordination, interventions and education to minimize barriers in managing chronic complex conditions within the delegated population. This position develops a member centered plan of care the implements, monitors, documents the utilization of resources, progress of the members throughout the continuum of care. The role will coordinate care and services based on the members unique health care needs.

Requirements

• Must possess knowledge normally obtained through the completion of a bachelor's degree in nursing and/or related field like community health, education, or health management.
• Must possess a current, valid RN license in state of practice, temporary/interim RN license in state of practice, or compact RN licensure for current state of practice.
• Certification for BLS is required for programs that are embedded in a clinical setting or conduct member community or home visit.
• Additional certification or continuing education may be required based on area of practice.
• Must possess knowledge of managing and coordinating care for members with chronic complex disease processes as normally obtained with 3 or more years’ experience providing direct patient care patient with chronic complex conditions in the acute care setting, nurse navigator and/or case management field.
• Requires excellent organizational skills, case management and clinical knowledge regarding specialty care services, as well as care coordination of services, legal and financial aspects of diagnostic services and health services in specialty area.
• Must possess ability to make autonomous decisions utilizing excellent clinical judgment.
• Must possess highly effective interpersonal and communication skills.
• Must understand the principles of quality customer service.
• Requires effective communication and writing skills, good time management skills and knowledge of word processing and database software applications.
• Requires the ability to teach both clinical and non-clinical personnel regarding care and diagnostics services.
• Also requires a good understanding of process improvement.
• May require off-site travel with personal vehicle (i.e. Corporate locations or member face-to-face visits within their homes, physicians’ offices, and/or community resources).
• Provide own transportation, required to possess a valid driver’s license, and be eligible for coverage under the organization’s auto insurance policy.

Nice To Haves

• Certification with a nationally recognized healthcare organization, such as CCM, preferred.
• Two years of experience directly related to Care Management in a Health Plan, Health Management, or Quality preferred.
• Additional related education and/or experience preferred.

Responsibilities

• Manages the members health, emotional and social needs across the health care continuum (longitudinal support) to achieve the optimal health management in the following areas: clinical, financial, operational, and member experience.
• Assess, triage and identify care coordination and chronic complex disease education needs based on member specific needs. Provides disease management education and interventions or identifies care coordination referral needs to in ancillary areas to provide optimal disease management support (i.e. pharmacy, registered dietician, social work, palliative, etc.).
• Provides care based on the best evidence available and may participate in research activities within clinical /case manager practice. Participates in unit or facility-based workgroups. Interacts and participates in the education, role development, and orientation of facility personnel, patients, students, families and visitors. Promotes/supports growth of others through precepting and mentoring when appropriate.
• Contributes to society through activities that lead to excellent members outcomes through timely, effective, efficient, equitable, and safe care. Actively participates in the improvement of national nursing and case management quality indicators and outcomes. Such activities may include participating in professional organizations.
• Educates internal members of the health care team on care management and managed care concepts. Facilitates integration of concepts into daily practice.
• Promotes a more active and informed role in patient self-care; navigates patients identified as high-risk across the continuum, longitudinally.
• Completes assessment and reassessments according to patient need and as outlined in policy and according to accreditation standards. Documents assessment, planning, implementation and evaluation in the patient member record. Documentation is legible, timely and in accordance with policy. Documentation reflects objective/subjective data, nursing interventions, education, care coordination and members progress to plan of care.
• Interacts with all levels of staff in a variety of departments, physicians, payers, members, families and external contacts, such as employees of other health care institutions, community providers and agencies, concerning the health care and case management needs of the member. Interacts with other health care providers in numerous settings in order to report and ask for or clarify information. Synthesizes and prioritizes data from multiple sources to provide support for the human response of the patient and family to changes in health status.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level