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Sanford Health RN Case Manager, Health Plan - Utilization Management in Sioux Falls, South Dakota

Job Title: RN Case Manager, Health Plan | Utilization Management | Sioux Falls

City: Sioux Falls

State: SD

Department : Utilization Management - Sioux Falls

Job Schedule: Full Time

Shift: Varies

Hours Per Shift: 8 hr

JOB SUMMARY

The Case Manager provides case management and care coordination for Health Plan members identified as high risk or with ongoing health conditions to ensure care is appropriate and cost effective. The Case Manager develops a care plan that includes education, counseling, and coordination of services for enrolled members to ensure all needs are met and recommended care is received. Possesses strong clinical knowledge and skills. The Case Manger will collaborate with team members both internally and externally to ensure care is coordinated and appropriate based on evidence based medicine. The Case Manager must be self-motivated with the ability to work independently, a problem solver and fiscally responsible. Ability to analyze, summarize, and present report data with effective oral and communication skills. Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Works primarily day hours. Works primarily telephonically in an office environment and onsite as needed. Travel may be required as necessary.

POSITION RESPONSIBILITIES

Work with individuals, groups, or families to plan or implement programs designed to improve the overall health of communities. Works with multidisciplinary teams to create an overall patient care plan. Coordination and management of care for patients, including those with complex needs. Accesses major system interfaces with authorization to obtain needed information (e.g. medical records, prescription and medical orders). Identifies risks and vulnerabilities; creates contingency plans. Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans. Explores own motivation and initiative and how it relates to the workplace. Recognizes changing demands and priorities; validates changes with management. Analyzes chart content and identify any mistakes that could impact patient care. Addresses documentation issues to support claim processing that is in-line with regulations and rules. Mixes internal and external resources to create cost-efficient, optimal project team. Implements or manages risk management for own area.

QUALIFICATIONS

Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE). Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA) is strongly preferred.

Will consider applicant with significant background in case management, transplant services and/or other utilization review experience. Minimum of 5 years nursing experience is required.

Currently licensed with the applicable state nursing board and/or possess multistate licensure privileges as required by position. Current Commission for Case Manager Certification (CCMC) is preferred or is to be obtained within 2 years of employment.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

City: Sioux Falls

State: SD

Job Function: Health Plan

Job Schedule: Full Time

Shift: Varies

Req Number: WD09289

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