Full-time opportunity for an RN Case Manager in our Care Management Department. Overview of Responsible for coordinating care for patients attributed to DaVita Medical Group. Collaborative care with patients, their providers, and various community resources to ensure assessment of medical conditions are completed then coordinate a plan of care with patient driven goals to meet individual healthcare needs. Promotes quality of care and cost effective outcomes. Serves as a resource for patients, teammates and providers. Ensures compliance to contractual and service standards as identified by relevant health insurance plans and DaVita Medical Group. This is performed under the direct supervision of the Medical Director, Care Management. Essential Functions: Provides case management coordination to ensure that patients receive the appropriate level of care based on medical needs. Develops alternate plans and assist patients and Providers to navigate the healthcare system optimizing benefits. Refer services to networked Providers when possible. Uses professional judgment and departmental guidelines to refer cases to physician advisors. Ensures compliance with HIPAA and other applicable company policies and procedures as well as regulatory requirements. Identify and address opportunities for quality improvement in all aspects of serving our customers. Assist in planning and implementation of systems changes and procedures to achieve overall organizational objectives. Maintain effective communication with management regarding development within areas of assigned and performs special projects as required. Performs other duties as assigned. Education: Required- Associates Degree in Nursing. Preferred- Bachelor s degree or higher in healthcare related field. Experience: Required- Three (3) years of previous job related experience in a healthcare environment. Preferred- Two (2) years experience providing case management and/or utilization review functions within health plan or integrated system. Required licensure: Required- Valid NM RN License or valid multi-state compact license. Preferred- Utilization Review or Case Management Certificate. Knowledge, Skills, Abilities: PC proficient; ability to communicate and interact professionally with co-workers, management patients, and Providers; ability to counsel and/or consult; working knowledge of HMO s, PPO s, Medicare, Medicaid, and insurance plans; knowledge of CPT4/ICD 9 & 10/HCPCS codes. DaVita Medical Group is one of the nation s leading medical groups and is a national medical group with operations in New Mexico, Nevada, Colorado, Florida, California and Washington. It is an exciting time to join DaVita Medical Group NM as we blaze new trails in coordinated care, setting the new standard in New Mexico for compassionate, cost-effective, high quality healthcare. If you re looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you. DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status. We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks. DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.
20 Nov, 2018