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:
- Telephonically engage assigned patients to specified cadence and frequency based on healthcare status and need. Build relationships and trust to support the patient and assist them as they navigate the healthcare ecosystem.
- Enroll patients in designated programs based on chronic conditions or recent events (discharges from Emergency Department or Inpatient facilities).
- Ensure patient adherence to assigned care plans and prescribed medications.
- Coordinate with aligned practices to ensure timely visits and follow-ups based on protocols for chronic condition and discharge management, close care gaps, and monitor timely refills to medications.
- Perform whole-person assessments for identified individuals. This includes physical, social determinants of health, and psychological barriers and concerns for members as appropriate. Leverage multi-disciplinary team members to address and resolve issues.
- Identify problems or gaps in care and offer opportunity for intervention.
- Collaborate as needed with providers, and other healthcare team members including inpatient case management staff and outpatient providers, to transition and facilitate care across the healthcare continuum to optimize clinical and financial outcomes.
- Cooperate with appropriate health care team members to perform root cause analysis on readmissions.
- Provide insights and recommendations for hospice and palliative eligible patients.
- Implement a member-centric care management plan, utilizing SMART goals, that address practitioner care goals, member/family concerns and available resources.
- Provide ongoing evaluation of the effectiveness of the plan of care in meeting established care goals through collaboration with the affiliated practice, patient, and/or family-caregivers.
- 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.
- Maintain accurate and timely documentation. Ensures documentation meets current standards and policies.
- Meet established goals for productivity including panel size, enrollment, retention, quality and standard call center metrics.
- Maintain 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.
- Abide by the organization’s compliance program and requirements.
- Maintain appropriate clinical licensure in good standing.
- Participate in regular team meetings and peer review activities. Participate in departmental and organizational committees, as applicable. Assist/support in the orientation of new personnel. Promote collaborative teamwork.
- Meet 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.
- Maintain appropriate professional boundaries.
- Interact respectfully and effectively with others, focusing upon the achievement of organizational goals and objectives through a commitment to teamwork.
- Appropriately update departmental leadership with necessary information.
- Utilize teach back methods with patient/caregiver.
- Support training of new telephonic staff members.
- Perform other duties as needed.
Requirements:
Education
- Associates degree in nursing required.
- BSN Preferred.
Licensure/Certification
- Must hold a current/active compact RN license.
- Licensure in additional states such as: IL, MI, NY, CA, NV, and PA a plus.
Required Experience
- Minimum two years of nursing-related care experience, preferably in a primary care office or call center setting.
- Case Management, Care Management, Care Coordination, telephone nursing management, and/or Disease Management experience.
Required Knowledge, Skills, and Abilities
- Knowledge of care management concepts along the continuum of care.
- Advanced clinical knowledge of chronic disease states.
- Motivational and behavioral interviewing.
- Experience and ability to use Microsoft Office products and word-processing software daily.
- Excellent written, verbal, and listening communication abilities. Communicate appropriately and clearly to members, coworkers, and providers.
- Ability to manage conflict, stress, and multiple simultaneous work demands in an effective and professional manner.
- Ability to successfully articulate the process of attaining goals and outcomes of care management.
- Ability to apply clinical knowledge and experience in a care management role.
- Ability to care to manage diverse populations without applying one’s own personal values.
- Ability to think critically and analytically and work with minimal supervision within the nursing scope of practice.
- Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development.
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