RN Care Manager
UHS
Summary
Under the supervision of the Care Management Clinical Program Manager, the RN Care Manager is responsible for providing care management services for medically and/or socially complex members. The target member population includes individuals with complex medical conditions, social-economic, or mental health needs. The goal of the program is to assist these members in achieving optimal health and/or independence in managing their care.
Job description
The RN Care Manager will demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient-centered, culturally sensitive care coordination, and management of complex members. The RN Care Manager will adhere to the CMSA Standards of Practice for Case Management.
The RN Care Manager is responsible for developing comprehensive care plans for member and family self-care competence, including motivational assessment, assessing for desired level of involvement, and coaching for adherence to the care plan. The RN Care Manager assesses the member’s needs, and creates and monitors a specific individualized care plan, including end of life planning.
The RN Care Manager promotes knowledge of the Care Management program to Prominence Health Plan contracted physicians, as well as members. In addition, s/he is responsible for developing and sustaining partnerships with community resources and support agencies.
Additionally, the position includes participation in efforts associated with the successful implementation and operation of the SNP CM program and that the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA.
Requirements
- Associate or Bachelor’s Degree in Nursing, required
- Active, unrestricted, current, and valid Compact Registered Nurse license in the States of Practice (Nevada, Texas and/or Florida), required
- Minimum of three (3) years in clinical nursing practice, required
- Certified Case Manager (CCM), Case Management Nurse – Board Certified (CMGT-BC), Accredited Case Manager – RN (ACM-RN), or Certified Managed Care Nurse (CMCN), preferred
- Minimum of three (3) years of Case Management/Transition of Care experience in a managed care outpatient or community environment, preferred
- Recent working knowledge of Special Needs Plan population, preferred
- Ability to effectively communicate in English
- Preferred Spanish, and/or Spanish, French Creole, and/or Tagalog, both verbally and in writing
- Bilingual; Spanish/English preferred
- Experience working with the Medicare and Medicaid population segment, preferred
- Knowledge of Medicare/Medicaid processes and compliance standards, preferred
Benefits
- Loan Forgiveness Program
- Competitive Compensation
- Generous Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plan
- 401(k) Matching
- Discounted Stock Plan
- SoFi Student Loan Refinancing
- Career Development Opportunities
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.