Clinical Onsite RN

Job Summary
This position will require an onsite presence at client's offices and/or clinics, as well as an ability to provide support to members within their local community. This position will support the client's vision of coordination of care extension to members who are seen by the onsite clinics or who are referred by one of the medical providers associated with the client's clinics. This nurse will need to create, implement, and monitor treatment plans that assist patients/members in meeting their healthcare goals. They will also need to use their knowledge of healthcare and social services to assess needs and provide interdisciplinary care options in treatment planning. It is crucial that this nurse understands the member's healthcare benefits and how to best utilize those benefits to assure effective treatment planning.

Essential Functions

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Work with clinic teams to assess and identify members who may benefit from additional resources/benefits under the insurance plan and work with the clinic teams to engage those members in Care Management program.
  
  Utilize claims and authorization data to assist clinic in identification of members with high dollar claims and/or overutilization of resources. Work with staff to engage member in care coordination services to assist with outpatient management to avoid future ER and inpatient admissions.
  
  Interpret individual health plans and authorizing/coordinating care in accordance with plan provisions.
  
  Assess the member's health status and care coordination needs. Can include inpatient review and discharge planning, as well as possible outpatient management.
  
  Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/client may also be required.
  
  Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner. (45%)
• Assessment of the clinical status and resultant sequela to coordinate the most appropriate service to meet the individual's health care needs. The Case Manager will then monitor the health status and the impact of the treatment plan for each client.
  
  The nurse will be responsible for altering the care plan as deemed appropriate by the dynamic, ever-changing client needs.
  
  When appropriate and when requested, the nurse will engage members/caregivers in the community - attend outpatient MD appointments, evaluate options for alternative levels of care, participate in home evaluations to ensure member/caregivers can comply with outpatient management orders and routines.
  
  If appropriate, the nurse will refer members into other Care Coordination programs that could support the member's ongoing healthcare needs. (25%)
• Assess and measure response to engagement
  
  Work with client and clinics to improve member experience and outpatient management beyond the clinic.
  
  Develop relationships with community resources and refer members to resources needed. (15%)
• Evaluate program effectiveness and assist client in measures to improve program promotion and outcomes.
  
  Assist client in developing new member programs that promote better health and actively participate with client in promotion of programs and encouragement of member engagement with programs. (15%)

Required Work Experience
7+ years related work experience. Experience Details: Professional background in clinical nursing, patient assessment, patient teaching and quality management skills

Required Management Experience
No supervisory/management experience required

Required Education
Related Bachelor's degree required Requires a degree from an accredited school of nursing

Required Licenses and Certifications
Current nursing license - if a candidate resides in a compact state a compact license is required

Additional Required Qualifications

Knowledgeable in medical terminology, reasonable and necessary treatment planning, delivery of humane and quality health
care services, and cost-containment practices

Strong written and verbal communication skills

Proficiency in maintaining good rapport with physicians, health care facilities, clients, and providers.

Ability to work across operational areas within the organization.

Proficient in Microsoft Office applications

Additional Preferred Qualifications
3+ years of clinical Case Management
Certification in Case Management (CCM)
Knowledge of managed care in the self-funded employer population would be beneficial.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.