• Health Plan Registered Nurse Case Manager

    Job Number
    222862
    Facility
    Univ Physicians Health Plans
    Department
    HP Statewide Util Mgmt
    Address : Street
    2701 East Elvira Rd
    Address : Location
    US-AZ-Tucson
    Additional Locations
    US-AZ-Mesa | US-AZ-Phoenix
    Work Schedule
    Day
    Position Type
    FT: Full-Time
    Posting Category
    Nursing - Case Management
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    Health care is constantly changing, and at Banner Health, we are at the front of that change. We are leading health care to make the experience the best it can be. We want to change the lives of those in our care – and the people who choose to take on this challenge. If changing health care for the better sounds like something you want to be part of, we want to hear from you. 

     

    The Utilization Management Department is responsible for all aspects of member's inpatient admission and discharge planning in all facilities. It is important to maintain the RN position to assist in maintaining regulatory compliance. The RN also assist Network Development Department with possible facility issues and expedite prior authorization with discharge planning. The RN collaborates with the case management staff to facilitate continuity of care for our members and to decrease readmissions.

     

    Requirements:

    Active Arizona RN license
    strong hospital background in utilization mgmt. with an understanding of MCG or Interqual. 
    Federal or State knowledge of health care regulations

     

    100% remote after 3-4wks training

    Mesa, Corp.

    525 W. Brown Rd.

    Mesa, AZ

     

    Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

     

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

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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 make health care easier, so life can be better. 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.

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