Population Health RN

Requirements

• 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 make 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 contracts/cases and make 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 related software and office equipment.
• Licenses and Certifications
• Active and unencumbered(current and unrestricted) RN license to practice in Louisiana is required.
• Multi-state Compact RN license is preferred.
• Multi-state Compact RN license is required within 6 months from date of hire.
• RN license in noncompact state is preferred.
• May be required to obtain additional RN licensure in noncompact state within 6 months from date of hire.
• Certified Case Management Certification is preferred.
• Certified Case Management Certification is required within 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 develop and implement a comprehensive case management plan.
• Implement a comprehensive case management plan.
• Implement specific case management activities and/or interventions and evaluate effectiveness that will lead 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 all of the case management plan's components if necessary.
• Utilizes behavioral interviewing techniques.
• Familiar with guidelines and requirements for authorizations of services related to coordination of care for complex cases

Benefits

Additional Information

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop 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 all 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 all 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, Underwriting, Group leaders, Delegated Vendors, Legal Department and other employees as needed, physicians/staff, hospital administrators/staff, providers, caregivers, subscribers, community resources.

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