Population Health RN Case Manager- NBMC Full Time Day Job Listing at NorthBay Healthcare in Fairfield, CA (Job ID 3226)

Description

The Utilization Management the Population Health RN Case Manager (PHRNCM) is responsible for providing complex case management (CCM) to diverse groups of high-risk capitated populations. Complex case management is defined as the coordination of care and services for members who need help navigating the healthcare system to facilitate the appropriate delivery of the right care and services at the right place and time. These services are provided utilizing available resources across a continuum of care and in collaboration with members, caregivers, medical home providers, and ancillary health care providers. NBH utilizes a Population Health approach to identify diverse groups and to enhance member engagement and coordinate care delivery across populations to improve clinical outcomes.

1. Education: Graduated from an accredited nursing school or college. BSN required. Masters prepared in nursing or other health related field preferred.
2. Licensure/Certification: Current California State RN License required. Certified Case Manager (CCM) or Accredited Case Manager (ACM) within (2) two years of starting the position. 
3. Experience: Minimum of (2) two years relevant clinical experience required. Minimum (1) one year case management experience required; equivalent case management education and/or experience will be considered.
4. Skills: 
   • Knowledge of personal computer with experience entering and retrieving data and MS Suite software specifically MS Word processing and/or good keyboard skills required. 
   • Ability to effectively communicate with all levels of patients, physicians, health care personnel, supervisory staff, and peers.
   • Demonstrates the exceptional ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
   • Demonstrates the willingness to research, learn, and obtain knowledge for the performance of the position.
   • Demonstrates a courteous, professional demeanor at all times either working individually or in a team environment working collaboratively in an effective manner maintaining  positive relationships with peers and supervisors alike.
   • Utilizes critical thinking, and applies sound clinical judgment and assessment skills for decision making.

       5.  Interpersonal Skills:  Demonstrates the NorthBay Way.  The NorthBay Way is a set of value-based behaviors that are to
            be consistently demonstrated and role modeled by all employees that work at NorthBay Healthcare. The NorthBay Way    
            principles consist of Caring, Communication, Collaboration, and Competence.  

      6.  Knowledge of:

• NCQA, DHS, CMS, JCAHO and EMTALA standards and federal and state regulations.
• Acute care, home care, subacute care, long-term care, hospice interventions, rehabilitation options, other community resources and requirements.
• Millimann, Interqual medical necessity guidelines.
• Expert knowledge of CPT and HCPC codes and related guidelines.
• Expert knowledge of ICE guidelines governing TAT, claims and the denial process. 
• Current standards and trends in health care, best practices, management tools, and familiarity with related resources and literature. 
• Capitiation and Managed Care legislation. 
• CMSA Standards of Practice

       7.     Hours of Work: Eight hour shift on scheduled days based on business need. This position may be approved for hybrid remote work.

      Compensation Based on years of experience $74.95-$86.27