Rn Care Manager - West

Who we are:

The healthcare system isn’t designed for health. We’re designed to change that.

We’re Wellvana, and we help doctors deliver life-changing healthcare.

Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it.

Our enlightened approach—covering everything from care coordination to coding to marketing— ties the healthy outcomes of patients directly to healthier earnings for primary care providers.

Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated 24/7 care that is nothing short of life changing.

Recently named by Insider as one of 33 startups “investors expect to take off in 2023,” we’re one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be.

The Role:

We're looking for a Registered Nurse with a compact license who embraces change and is not afraid of a challenge. The RN Care Manager is responsible for managing rising risk and high-risk members to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and financial outcomes. The RN Care Manager will formulate and implement a care management plan that addresses the members identified needs by assessing concerns/barriers, resources, and care goals. The RN Care Manager will advocate for the member and support the member in navigating the health care system via ongoing engagement.

When applicable, the RN Care Manager will work collaboratively with the interdisciplinary care team and the member’s primary care provider to identify and support the achievement of the member's short-term and long-term health goals. The RN Care Manager provides education and resources to members and/or responsible parties, to reduce preventable emergency room visits, hospitalizations, and re-admissions.

What you'll do:

• Interacts respectfully and effectively with others, focusing upon the achievement of organizational goals and objectives through a commitment to teamwork.
• Cooperates with appropriate health care team members to perform root cause analysis on readmissions.
• Revises the plan of care as needed to reflect changing needs, issues and goals and monitors and evaluates the progress of the member at prescribed minimal intervals.
• Provides insights and recommendations for hospice and palliative eligible patients.
• Performs other duties as needed.
• Maintains appropriate professional boundaries.
• Utilizing different technologies and/or telephonically engages members recently discharged from emergency department and acute inpatient stays and who are at elevated risk for admission and readmission.
• Considers teaching methods based on individual needs/differences.
• Strives to meet established goals for productivity.
• Provides ongoing evaluation of the effectiveness of the plan of care in meeting established care goals through collaboration with the healthcare team, member and/or family-caregivers.
• Supports training of new telephonic staff members.
• Performs initial and periodic whole-person assessments for identified individuals. This includes physical, social determinants of health, and psychological barriers and concerns for members as appropriate.
• Maintains accurate and timely documentation. Ensures documentation meets current standards and policies.
• Participates in regular team meetings and peer review activities. Participates in departmental and organizational committees, as applicable. Assists/supports in the orientation of new personnel. Promotes collaborative teamwork.
• Identifies and effectively utilizes community resources to meet the needs of members/families.
• Facilitates member access to community resources as appropriate.
• Appropriately updates departmental leadership with necessary information.
• Collaborates as needed with providers, and other healthcare team members including inpatient care management staff and outpatient providers, to transition and facilitate care across the healthcare continuum to optimize clinical and financial outcomes.
• Identifies problems or gaps in care and offers opportunity for intervention.
• Maintains appropriate clinical licensure in good standing.
• Meets with care management leadership team and the care management/clinical coordination team on a regular basis to provide member updates identify issues and develop strategies for resolution.
• Uses analytics and practitioner referrals in identifying appropriate members for care management, utilizing established care management criteria.
• Formulates and implements a member-centric care management plan, utilizing SMART goals, that address practitioner care goals, member/family concerns and available resources.
• Maintains a working knowledge of, and adheres to applicable federal and state regulations including, but not limited to, laws related to patient confidentiality, the release of information, and HIPAA.
• Utilizes motivational interviewing techniques to engage members in goal setting.
• Abides by the organization’s compliance program and requirements.
• Prioritizes caseload to balance member and departmental needs.

Education

• Associates degree in nursing required
• BSN Preferred

Licensure/Certification

• Must hold a current/active compact state RN license

Required Experience

• Five years of nursing-related care experience
• Case Management, Care Management, Care Coordination, telephone nursing management, and/or Disease Management experience

Required Knowledge, Skills, and Abilities

• Ability to care to manage diverse populations without applying one’s own personal values
• Motivational and behavioral interviewing?
• Knowledge of care management concepts along the continuum of care
• Ability to think critically and analytically and work with minimal supervision within the nursing scope of practice.
• Experience and ability to use Microsoft Office products and word-processing software daily
• Ability to apply clinical ?knowledge and experience in a care management role
• Ability to manage conflict, stress, and multiple simultaneous work demands in an effective and professional manner.
• Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development
• Advanced clinical knowledge of chronic disease states
• Excellent written, verbal, and listening communication abilities. Communicate appropriately and clearly to members, coworkers, and providers.
• Ability to successfully articulate the process of attaining goals and outcomes of care management