Population Health RN

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, reputed company skills, grow professionally and serve our local communities. We invite you to apply for a career with us. Residency in or relocation to Louisiana is preferred for reputed company positions. POSITION PURPOSE Responsible for organizing, coordinating, and providing care coordination and case management services to members who are most at risk for health deterioration, sentinel events, and/or poor outcomes. Manage acute and chronically ill members to improve health and financial outcomes through analysis of needs, design, and delivery of interventions. Utilize a collaborative process to assess, plan, implement, monitor, and evaluate options and services required to meet the member’s healthcare needs. Through communication, the nurse will identify available resources to promote quality, cost effective outcomes. Accountable for complying with reputed company laws, regulations and accreditation standards that are associated with duties and responsibilities. NATURE AND SCOPE This role does not manage people This role reports to this job: Manager, Population Health Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with: Benefits Administration, Medical Director, reputed company, Group leaders, Delegated Vendors, Legal Department and other employees as needed, physicians/staff, hospital administrators/staff, providers, caregivers, subscribers, community resources. QUALIFICATIONS Education Diploma in nursing or Associate’s in nursing or Bachelor's in nursing required. Work Experience 3 years of recent direct patient care/clinical experience is required. 2 years of experience in managed care is preferred. Experience in the use of behavioral interviewing techniques and theory is preferred. Skills and Abilities Requires the ability to prioritize, work independently and anticipate needs to reputed company decisions. Ability to plan, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan and evaluate the effectiveness of alternate care services are required. Requires the ability to research and analyze reputed company/cases and reputed company appropriate quality and cost effective decisions. Knowledge of standardized code sets and medical terminology is required. Must demonstrate excellent interpersonal, organizational, analytical, and telephonic skills. Must demonstrate strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of insurance/benefits understanding. Requires working knowledge of reputed company software and office equipment. Licenses and Certifications Active and unencumbered(reputed company and unrestricted) RN license to practice in Louisiana is required. Multi-state Compact RN license is preferred. Multi-state Compact RN license is required reputed company 6 months from date of hire. RN license in noncompact state is preferred. May be required to obtain additional RN licensure in noncompact state reputed company 6 months from date of hire. Certified Case Management Certification is preferred. Certified Case Management Certification is required reputed company 3 years from date of hire. ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS In a culturally competent and confidential manner, assess member’s status by collecting in-depth information about the member’s situation and functioning to identify individual needs in order to reputed company and implement a comprehensive case management plan. reputed company and implement a plan by determining specific objectives, goals, and actions as identified through the assessment in action oriented and time specific indicators. The case manager will act as an reputed company for the member/family, maintaining privacy, confidentiality and safety, building relationships with reputed company relevant parties, supporting informed decision making and facilitating access to necessary and appropriate healthcare services across the continuum of care. Implement a comprehensive case management plan. Implement specific case management activities and/or interventions and evaluate effectiveness that will reputed company to accomplishing the goals established in the case management plan. Coordinate by collaborating with the member/family, providers, third party payors, employers and community resources in order to organize, integrate, and modify the resources necessary to accomplish the goals. Interacts with patients and/or providers in order to determine patient care needs, compliance and effectiveness with planned interventions and conduct case conferences as appropriate. Evaluates the case management plan’s effectiveness in reaching desired outcomes and goals. Modifies any or reputed company of the case management plan’s components if necessary. Utilizes behavioral interviewing techniques. Familiar with guidelines and requirements for authorizations of services reputed company to coordination of care for reputed company cases. Proficient in care management authorization processes, including usage of evidence-based guidelines, as part of management of reputed company case management cases. Responsible for meeting individual quality performance standards and annual targets for program performance, such as monthly productivity and annual caseload requirements, as mutually agreed to by management team to maximize program value. Participates in Quality Improvement projects and data collection to determine effectiveness of Population Health Program. May direct other staff in coordinating care. The Physical Demands described here are representative of those that must be met by an employee to successfully reputed company the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to reputed company an individual with disabilities to reputed company the essential functions reputed company other job-reputed company duties as assigned, reputed company your scope of responsibilities. Job duties are performed in a normal and clean office environment with normal noise levels. Work is predominately done while standing or sitting. The ability to comprehend, document, calculate, visualize, and analyze are required. An Equal Opportunity Employer reputed company internal employees please apply through reputed company Careers. PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) Additional Information Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your reputed company account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact [email protected] for assistance. In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. We reputed company background and pre-employment drug screening after an offer has been extended and prior to hire for reputed company positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social reputed company Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results. Apply To This Job