RN Case Manager

Job Number
204339
University Physicians Health Plans
Shift
Day
Department
University Physicians Health Plans - HP Statewide Cond Mgmt
Position Type
FT: Full-Time
Internal Code A
COREHTF
Street Address
2701 E. Elvira Rd.
City & State
US-AZ-Tucson
Posting Category
Nursing - Case Management
New Grad
No

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If you are a New Graduate Nurse with less than 12 months of experience, please apply to our New Nurse Experience openings.


 

Banner University Health Plans is currently seeking an RN Case Manager.  The RN Case Manager can be based in either Tucson or Phoenix.

 

The position provides multifaceted healthcare navigation assistance to members and caregivers, and providers in accordance with regulatory compliance standards. The RN Case Manager is the leader in ensuring the High Need/High Cost members receive integrated physical and behavioral health, facilitate care coordination of D-SNP members by formulating care plans with members/providers, lead interdisciplinary care team rounds, collaborate with UM RN to ensure member transitions to home or other care settings are safe thus having an impact on readmissions.

 

Schedule:

Monday-Friday; 8:00AM-5:00PM (time frame is flexible)

 

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About University Physicians Health Plans
The University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care.

 



Truven-2013
Stage7-2013

About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to change the way care is provided. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care.


Essential Functions

  • Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.

  • Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.

  • Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.

  • Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues.

  • 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 case management and managed care concepts. Facilitates integration of concepts into daily practice.

  • May supervise other staff.

  • Minimum Qualifications

    Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care.

    Requires current Registered Nurse (R.N.) license in state worked. For assignments in an acute care setting, Basic Life Support (BLS) certification is also required.

    Requires a proficiency level typically achieved with 3-5 years clinical experience. Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format. For assignments in an acute care setting, must be able to work flexible hours and take rotating call after hours. Banner Registry and Travel positions require a minimum of one year experience in an acute care hospital and/or home care setting. Experience must include working in an acute care and/or home care setting within the past 12 months as a Case Manager in the specialty area.

    Preferred Qualifications

    CCM (Certified Case Manager) preferred

    Additional related education and/or experience preferred.