- 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.
- Associates degree in nursing required?
- BSN Preferred?
- ?Must hold a current/active TN compact RN license?
- 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?
- Team members will be based out of the headquarters location in Green Hills, TN.
- As performance metrics are achieved and maintained, there is opportunity for hybrid work
- Shifts may vary?
- 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?
-
RN Care Manager
6 days ago
Wellvana Integration Partners, LLC Nashville, United StatesJob Description · Job DescriptionDescription: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 s ...
-
RN Care Manager
1 week ago
Wellvana Integration Partners, LLC Nashville, TN, United States Full time: 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 misali ...
-
Nurse Care Manager
1 week ago
Lucent Health Solutions, Inc. Nashville, United StatesNurse Care Manager · Role Summary · The role of the Nurse Care Manager is responsible for assisting patients diagnosed with complex illnesses, recovering from a traumatic clinical event, or managing multiple clinical co-morbidities. The NCM leads the development and ongoing mana ...
-
RN Care Manager
1 week ago
Wellvana Nashville, United StatesThe 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 misaligne ...
-
RN Care Manager
2 days ago
Wellvana Integration Partners, LLC Nashville, TN, United States: · 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 misalig ...
-
Managed Care Specialist
1 week ago
Crescens Nashville, United StatesTitle: Managed Care Specialist · Location: Nashville, TN · Duration: 12 Months · Type: Contract · Job Description: Determine individual and family eligibility for our Client's care programs. · ssist in coordinating and communicating schedules to internal/external Clients. · Co ...
-
RN Care Manager
20 minutes ago
Wellvana Integration Partners, LLC Nashville, United States: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 misalign ...
-
Managed Care Specialist
1 week ago
Expedite Technology Solutions LLC Nashville, United StatesOur Client is looking to hire a Legal Assistant for an onsite role in their downtown Nashville, TN location. · No duplicate submissions. · Our Client provides their workforce with a hybrid work environment. Most positions have a combination of work from home and work in the offic ...
-
RN Care Manager
1 week ago
Ascension Nashville, TN, United StatesDepartment: Case Management · Schedule: Monday-Friday 8:00A - 4:30P (some holidays and weekends) · Hospital: St Thomas West · Various health insurance options & wellness plans · Retirement benefits including employer match plans · Long-term & short-term disability · Employee ...
-
RN Care Manager
2 weeks ago
Ascension Nashville, TN, United StatesDepartment: Case Management · Schedule: Monday-Friday 8:00A - 4:30P (some holidays and weekends) · Hospital: St Thomas West · Various health insurance options & wellness plans · Retirement benefits including employer match plans · Long-term & short-term disability · Employee ...
-
Managed Care Specialist
1 week ago
Vlink Nashville, United StatesJob Description: The preferred candidate should have a bachelor's degree from an accredited college or university and four years of full-time increasingly responsible professional staff administrative experience. Qualifying full-time increasingly responsible sub-professional, par ...
-
Managed Care Specialist
1 day ago
Lorven technologies Nashville, United StatesJob Description · Job DescriptionRole: Managed Care Specialist · Location: Nashville, TN · Duration:6 month Contract Key ResponsibilitiesDetermine individual and family eligibility for our Client's care programs. · Assist in coordinating and communicating schedules to internal/e ...
-
Managed Care Specialist
1 week ago
APN Staffing & Employment Solutions Nashville, United StatesJob Description · Job DescriptionManaged Care Specialist · Nashville, Tennessee · This a long-term project position and is a Hybrid. Hours are (8:00 am to 4:30 pm Monday-Friday) Hourly rate of pay for this project is $19.50 an hour. · GENERAL RESPONSIBILITIES: · Help determine i ...
-
Managed Care Paralegal
1 week ago
HCA Healthcare Inc Nashville, United States Full time· Description · Introduction · Do you want to join an organization that invests in you as a(an) Paralegal? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. · Ben ...
-
Managed Care Paralegal
1 week ago
HCA Healthcare Nashville, United States Full timeDescription · Introduction · Do you want to join an organization that invests in you as a(an) Paralegal? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. · Benefit ...
-
Managing Counsel Managed Care Litigation
1 week ago
HCA Nashville, United StatesThis position is incentive eligible. · Introduction · Do you want to join an organization that invests in you as a(an) Managing Counsel? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the ...
-
Managed Care Contract Analyst
2 days ago
e CancerCare Nashville, United StatesJob Purpose: Contract Analyst will be responsible for analytic support related to ION network and providers. Team member will work closely with the Managed Care department team in generating and reviewing system data, while making strategic recommendations. The role includes load ...
-
Clinical Care Manager II
1 week ago
Elevance Health Nashville, United StatesA proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs f ...
-
Manager, Care Delivery Operations
3 days ago
Thyme Care Nashville, United StatesJob Description · Job DescriptionOUR MISSION · Thyme Care is on a mission to ensure every cancer patient receives the highest-quality care. By collaborating across the cancer care community, we're improving access, experience, and outcomes while lowering the total cost of care fo ...
-
Case Manager, Foster Care
1 week ago
Centerstone Nashville, United StatesCenterstone is among the nation's leading nonprofit behavioral health systems with thousands of employees dedicated to delivering care that changes people's lives. A dynamic, well-established organization, we offer rewarding opportunities to serve all ages in a variety of setting ...
RN Care Manager - Belle Meade, United States - Wellvana Integration Partners, LLC
Description
: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.
We're looking for a Registered Nurse (RN) Care Manager with a compact license to remotely manage the holistic needs of rising risk and high-risk patients, to streamline the quality and delivery of care and improve health outcomes. The RN Care Manager operates as an extension of Wellvana partner practices and health systems to support an assigned panel of patients identified for additional support or those recently discharged after an Emergency Department visit or Inpatient stay. The RN Care Manager will advocate for the patient and help navigate the health care system via targeted interactions and coordination with their primary care provider. The RN Care Manager will monitor each patient's progress to their assigned care plan and assess concerns/barriers, available resources and support and social determinant of health needs. The RN Care Manager will leverage multidisciplinary care team members (Licensed Clinical Social Workers, behavioral health specialists, Medical Assistants, Pharmacists and Pharmacy Technicians, etc) to provide personalized and comprehensive care and support, educate the patient on their conditions and opportunities for improvement, and to resolve identified patient needs and barriers. This is an extremely rewarding role for an RN looking to build strong relationships and have a life changing impact on patient health.
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:
Education
Licensure/Certification
Required Experience
Location & Shift?
Required Knowledge, Skills, and Abilities
PIc77c9e405cb