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RN Care Manager

Company: DaVita Medical Group
Location: Albuquerque
Posted on: November 10, 2019

Job Description:

Full-time opportunity for an RN Care Manager in our Care Management DepartmentOverview of Position: Responsible for coordinating care for patients attributed to DaVita Medical Group.? Collaborative care with patients, their providers, and various community resources to ensure assessment of medical conditions are completed then coordinate a plan of care with patient driven goals to meet individual healthcare needs.? Promotes quality of care and cost effective outcomes.? Serves as a resource for patients, teammates and providers. ?Ensures compliance to contractual and service standards as identified by relevant health insurance plans and DaVita Medical Group.? This is performed under the direct supervision of the Medical Director, Care Management.Essential Functions:

  • Provides case management coordination to ensure that patients receive the appropriate level of care based on medical needs.?
  • Develops alternate plans and assist patients and Providers to navigate the healthcare system optimizing benefits.? Refer services to networked Providers when possible.
  • Uses professional judgment and departmental guidelines to refer cases to physician advisors.
  • Ensures compliance with HIPAA and other applicable company policies and procedures as well as regulatory requirements.
  • Identify and address opportunities for quality improvement in all aspects of serving our customers.? Assist in planning and implementation of systems changes and procedures to achieve overall organizational objectives.
  • Maintain effective communication with management regarding development within areas of assigned responsibilities and performs special projects as required.
  • Performs other duties as assigned.Education:Required- Associates Degree in NursingPreferred- Bachelor?s degree or higher in healthcare related fieldExperience:Required- Three (3) years of previous job related experience in a healthcare environment.Preferred- Two (2) years? experience providing case management and/or utilization review functions within health plan or integrated system.Required licensure: Required- Valid NM RN License or valid multi-state compact licensePreferred- Utilization Review or Case Management Certificate.Knowledge, Skills, Abilities:PC proficient; ability to communicate and interact professionally with co-workers, management patients, and Providers;? ability to counsel and/or consult; working knowledge of HMO?s, PPO?s, Medicare, Medicaid, and insurance plans; knowledge of CPT4/ICD 9 & 10/HCPCS codes.What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you?ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: DaVita Medical Group, Albuquerque , RN Care Manager, Executive , Albuquerque, New Mexico

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