- Associate or Bachelor's Degree in Nursing
- Registered nurse (RN) license (must have a current unrestricted RN license), BSN strongly preferred.
- 3 years of case management, utilization management, disease management, or behavioral health case management experience
- Equivalent combination of education and experience.
- Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.
- Master's degree in Behavioral Health related field with a current, unrestricted independent clinical license (ex. LCSW, LICSW, LMHC, LPC, or LMFT)
- 3 years of case management, utilization management, disease management, or behavioral health case management experience
- Experience working in an Integrated Behavioral Health-Medical model preferred
- Equivalent combination of education and experience.
- Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.
- Knowledge of health insurance industry trends, technology, and contractual arrangements.
- Proficiency in general computer skills, including Microsoft Office, Outlook, and internet search.
- Strong oral, written, and interpersonal communication and customer service skills.
- Ability to interpret policies and procedures, make clinical decisions, and communicate complex topics effectively.
- Strong organization and time management skills with the ability to manage workload independently.
- Ability to think critically and make decisions within individual role and responsibility.
- Patient-focused approach to problem solving, prioritizing optimal health outcomes for each member.
- Drive member behavior change, health coach/lifestyle modification, social determinants of health remediation, intensive coordinated transitions of care, engagement of family members, and direct collaborative provider engagement.
- Serve as the individual's single point of contact with no (or few) handoff's to other disciplines.
- Assesses four potential problem domains including medical, behavioral, social and health system using a holistic approach.
- Identify an individual's barriers to health improvement and compliance by utilizing a narrative relationship-based approach to assessing health complexity.
- Leverage the individual's motivation for change and create prioritized interventions based on the individual's goals.
- Establishing and measuring outcomes based on care plan goals as well as clinical, functional, economic and quality of life outcomes.
- Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring, and evaluation.
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Integrated Care Management Nurse or Clinician - Lewiston, United States - Cambia Health Solutions, Inc
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Description
Integrated Care Management Nurse or Clinician
Work from home within Oregon, Washington, Idaho, or Utah
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of Care Management Nurses and Clinicians are living our mission to make health care easier and lives better. As a member of the Care Management team, our Care Management Nurses and Clinicians provide clinical care management to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes - all in service of making our members' health journeys easier.
Do you enjoy working collaboratively with members and their multidisciplinary care team to ensure their needs are being met and voices are being heard? Do you enjoy staying current with the latest clinical practices and guidelines in your field to ensure members care is top tier? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Integrated Care Management Nurse:
Integrated Care Management Clinician:
Skills and Attributes:
What You Will Do at Cambia:
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