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Banner Health RN High Risk Case Manager in Mesa, Arizona

Primary City/State:

Mesa, Arizona

Department Name:

Health Mgmt

Work Shift:

Day

Job Category:

Clinical Care

The future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.

Join the Population Health Management team! Population Health is focused on supporting our members at home to have optimal health management. This team provides case management services across the care continuum and focuses on preventive management to reduce risks associated with chronic diseases. We meet our members where they need us most, right in the communities the live in! Population Health provides a multidisciplinary approach with a team of RN High Risk Care Managers, Health Partners (Social Workers), Registered Dieticians, Certified Diabetic Educators and Health Service Navigators to support the communities we provide services to. In this role you will provide case management support to members at home to ensure they stay well at home. This includes telephonic and in-home support in order to provide chronic disease management education, connection to community resources, caregiver support and coordination of care for optimal health management.

Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits 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.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position will be responsible to manage the complex chronic and rising risk members in the populations where care management is delegated to do so. He/she will be the main point of contact for members and providers across care settings. The aim is to better manage patients in the ambulatory setting by following patients deemed as or of becoming heavy users of care due to multiple chronic illnesses, high ED utilization, or a recent discharge from a skilled nursing facility, etc. The RN engages the appropriate resources within the multidisciplinary team to achieve optimal results for the patient, family, and care givers. This position provides comprehensive care coordination for patients as assigned. This position assesses the patient’s 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.

CORE FUNCTIONS

  1. Manages individual patients across the health care continuum (longitudinal support) to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Provides disease management or referral to disease management support in ancillary areas (i.e. pharmacy, social work, palliative, etc.)

  2. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient care plan. Effectively communicates the plan across the continuum of care. Ensures care plan consistency across providers.

  3. Acts in a leadership function with process improvement activities for populations of patients. Provides patient monitoring, education, and supports patient care plan adherence.

  4. Promotes a more active and informed role in patient self-care; navigates patients identified as high-risk across the continuum, longitudinally.

  5. 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.

  6. Educates internal members of the health care team on care management and managed care concepts. Facilitates integration of concepts into daily practice.

  7. This position has the freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are entity based with no budgetary responsibility. Internal customers: All levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team. External customers: Physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

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.

3 years of experience directly related to Care Management in a Health Plan, Health Management, or Quality.

PREFERRED QUALIFICATIONS

Certification with nationally recognized healthcare organization, such as CCM, preferred.

Additional related education and/or experience preferred.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

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