Care Manager Nurse II (remote available) - #9181969

Wellmark, Inc.


Date: Aug 18, 2022
City: Des Moines, IA
Contract type: Full time
Wellmark, Inc.

Job Description

Are you a dedicated, caring health care professional motivated and inspired by the opportunity to provide ongoing personalized support and education to our members? Do you thrive in fast-paced work environments where your time management, prioritization, and multi-tasking skills are critical to success? Do you love coaching and mentoring others and contributing to process improvement efforts?  Do you enjoy working with chronic kidney disease, end-stage renal disease, dialysis and transplant members?  If so, consider applying for our Care Manager Nurse II role!

Our Care Manager Nurse II serves as key advisor who actively engages with members through a variety of channels to foster a caring and trusting level of connection in order to support their chronic and/or complex health care needs and concerns. Creates and manages unique, individualized care plans that ensure the best possible health care goals for the chronic and/or complex health needs can be reasonably met. Partner with members, members’ families, health care providers and community resources to coordinate and facilitate the care and services provided. Function as informal leader of a forward-thinking, innovative team which continuously looks for ways to improve processes, health outcomes and maximize health dollars for our members; provide cross training to other nurses as needed.

Must be flexible and have the ability to take evening or weekend calls for members who need this arrangement.

Qualifications

Required:

  • Completion of an accredited nursing program.
  • Active and unrestricted RN License in Iowa or South Dakota. Individual must be licensed in the state in which they reside.
  • Certified Case Manager (CCM).
  • 4+ years of diverse clinical experience (e.g., acute care, outpatient, home health, etc.) that reflects 4+ years of direct clinical care to the consumer and management of complex cases or care plans with increasing levels of accountability; demonstrates a proactive approach.
  • 3+ years of experience in care management or health insurance setting beneficial. Experience with Wellmark products and requirements preferred.
  • Demonstrates leadership capabilities, including the ability to coach other care team members and guide/direct team activity toward interventions that support members' care plans.
  • Strong verbal communication skills; influences action and facilitates crucial conversations regarding care with members, physicians, and care facilities.
  • Exceptional ability to develop trusting relationships and maintain courtesy and professionalism when engaging with others.
  • Strong written communication skills, including accurate documentation of events within the care management platform; ensures quality and consistency by following guidelines and processes.
  • Commitment to service excellence and member advocacy; uses critical thinking and problem-solving skills to anticipate member and provider needs.
  • Resourceful self-starter who demonstrates strong understanding of resources, processes, and guidelines. Able to make independent decisions or recommendations under ambiguity.
  • Ability to organize and manage multiple priorities in a dynamic work environment where quality and/or production goals are measured. Commitment to timeliness, follow up, accuracy and attention to detail. Flexible and adapts to change.
  • Strong technical acumen; learns new systems quickly - e.g., Microsoft Office, clinical documentation platforms, etc.
  • Demonstrated, strong knowledge of standards and regulations - e.g., URAC, NCQA, HIPAA, PHI confidentiality.
  • Ability to take evening or weekend calls as needed to meet member needs

Preferred:

  • Care navigation/care coordination experience strongly preferred.
  • Prior experience and knowledge in managing chronic kidney disease, end stage renal disease and/or dialysis, or transplant.

Additional Information

a. Utilize critical thinking to recognize signs and symptoms of potential high-risk and complex conditions that warrant different or greater levels of support and proactively anticipate member needs in the navigation of the health care system and the benefits and resources available.

b. Discuss the complex care needs with the member through supportive, focused intervention methods and effective planning techniques. Handles escalated cases with legal, payment, and provider complexity (i.e., payment issues, network issues, etc.).

c. Proactively identify barriers and gaps to care while designing, creating, and managing unique, individualized care plans that ensure members/providers have good communication channels, that members receive appropriate care, that potential duplication of services effort is avoided, and education is provided to help enable them to achieve the best possible health care goals.

d. Partner with members, members’ families, health care providers and community resources to coordinate and facilitate the care and services needed.

e. Collaborate and coordinate with care team members who are providing additional support and resources in the overall management of individual member care needs. Ensuring that all care team members are acting in a coordinated manner to improve care outcomes.

f. Actively engage members as participants in their unique care management plan and educate on their personal accountabilities and expected outcomes. Advise on included benefits and services that are appropriate for their current medical status, and how those benefits and services can positively impact not only their medical status, but also the total cost of care.

g. Stay curious and engaged by actively continuing to partner with other members of the Care Team and research appropriate resources and/or programs as science and technology evolves, that may help to improve the health of assigned members going forward. Continue collaborative efforts with other clinical and nonclinical stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member and coordinate care. Facilitate additional referrals to providers, community resources/programs, and specific Wellmark programs, as necessary.

h. Using relevant technology tools, document care management activities accurately, consistently, and timely by following the standard work guidelines and policies to support internal and external processes. Comply with regulatory standards, accreditation standards and internal guidelines. Remain current and consistent with the specific standards pertinent to the Care Management team.

i. Other duties as assigned.

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.  


An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

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