As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
CCCS uses a holistic approach to medical management. The Personal Health Nurse (PHN) works within a team to move the member through the continuum of medical management with the goals of facilitating quality health care through the most cost effective means. The PHN performs the Personal Health Management process: assess the member; work with the member, family and physician to identify problems; establish goals and develop plans of care; coordinate services; educate members; and empower members to independently self-manage and to make knowledgeable health care decisions. The PHN works closely with the provider(s) to ensure that services are provided in the most appropriate setting by the appropriate provider(s) by performing functions of Personal Health Management as well as some functions of Utilization Management. Additionally, the PHN interfaces with clients and with CCCS client managers and are responsible for the medical management of designated client(s). All Medical Management Nurses practice within the scope of their licensures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Manages accounts using the 4-Prong approach, meeting expected number of billable hours and using Conifer Value Based Care tools (CCOO) according to standard protocol. Documents accurate Status, Sub-status, Patient Severity, Medical Management Acuity
Reviews daily calendar for new episodes and tasks due, prioritizes tasks on calendar
Completes a Personal Health Management assessment incorporating analysis of clinical claim chart, discussions with the member and the physicianï¿½s assessment and treatment plan
Determines and documents memberï¿½s goals, engages the member in the personal health management process. Develops an ongoing individualized plan of care with timeframes, reasonable and appropriate expected outcomes, specific planned interventions and memberï¿½s goals. Follows through with interventions and documents outcomes in Current Clinical Status section of care plan
Engages the PCP and treating physicians in the personal health management process, Collaborates with the member and PCP in development of an individualized plan of care
Closes episodes as indicated, i.e. evaluates ï¿½Impactabilityï¿½ among other indications for closure.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Understanding of CCCS holistic approach to medical management
Understanding of the clientï¿½s (customerï¿½s) perspective and needs
Understanding of legislative acts, such as the ADA
Competency in Word
Competency using email, attachments
Excellent verbal communication skills with the ability to communicate with members and communicate professionally with individuals who serve in a variety of functions, i.e. physicians, client managers, customer service staff, CCCS executive management, other CCCS Medical Management nurses, hospital utilization review nurses, etc.
Excellent written communication skills with the ability to write in a professional, business manner
Ability to analyze and resolve complex problems
General understanding of cost containment and how it relates to medical management
Excellent organizational, prioritization, and time management skills
Ability and willingness to function both independently and as part of a team
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Bachelor degree in a health related field
Five (5) years of UM/CM experience preferred
Three to five (3-5) years of diverse clinical experience required
Include minimum certification required to perform the job.
RN (Registered Nurse) license required
Current active professional license in the state of residence
Eligibility for unrestricted professional licenses in all states
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Remote Work Environment
Approximately 5 ï¿½ 30 % travel may be required dependent on the client assigned
Primary Location: Rhode Island
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1905035379
About Conifer Health Solutions
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.