RN Telehealth Full-time
HealthPartners

RN Case Manager

HealthPartners Bloomington, MN, US
Job Description

HealthPartners is hiring an RN Case Manager. This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

Accountabilities

  • Member Focus
    • Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
    • Identifies interventions and resources to assist member reaching personal health related goals.
    • Identifies patterns and episodes of care that are predictive of future needs and services.
  • Integration
    • Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
    • Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.
    • Adheres to department policy and procedure in daily activities.
    • Coordinates service coverage with appropriate funding sources when indicated.
    • Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
  • Communication
    • Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
    • Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
    • Provides educational information and materials to members to support preference sensitive decisions.
    • Provides regular reporting of member outcomes to Case Management leadership according to defined process.
    • Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
    • Identifies and promptly reports high cost cases for reinsurance.
    • Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
    • Maintains confidentiality of information in accordance with department and corporate policies.
  • Relationships and Team Building
    • Establishes and maintains good working relationships within the Case Management department, with other HealthPartners departments, and with other health team participants.
    • Supports other team members in achieving patient centered goals.
    • Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
    • Participates in and contributes to appropriate departmental and/or organizational meetings.
  • Technology
    • Maintains knowledge of and effectively uses automated applications and systems.
    • Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
    • Maintains maximum individual productivity through proficient use of automated systems.
  • Personal Development
    • Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.
    • Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
    • Maintains current, active Minnesota nursing licensure.
    • May maintain current, active nursing licensure in other states as assigned.
  • Other Duties
    • Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
    • Performs other duties as assigned.
Current Dimension

  • Directly reports to Supervisor, Case Management.
  • Directly manages caseload with anticipation of up to 85 members with complex needs.
  • Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care.

Required Qualifications

  • Registered Nurse with current unrestricted license in the State of Minnesota, BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure.
  • Minimum of 3 years clinical practice experience in an acute care setting; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.
  • Demonstrated effective, independent nursing judgment and skills.
  • Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.
  • Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.
  • Demonstrated skill in effective use and management of automated medical management systems.
  • Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
  • Basic computer skills

Challenges

  • Maintaining member focus in a rapidly evolving environment.
  • Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.
  • Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department.

Decision-making

  • Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.
  • Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.
  • Makes recommendations to leadership regarding policy development needs and/or changes.

About Us

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed To Support Your Total Health

As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.

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This includes establishing an intentional therapeutic relationship between a registered nurse and a patient and family. As a leader and the integrator of care, the professional nurse has the responsibility, authority, and accountability for planning, coordinating and evaluating the patient’s care needs. Provides nursing care across patient care departments in alignment with the nurses experience and competencies. Principle Responsibilities Comprehensive assessment of patient and family needs; identification of outcomes based on needs assessment; establishing the plan of care; supervising the progress; and modification of the plan of care as needed. Maintains education and competencies to remain proficient to provide high quality patient care practice and skills. Incorporates evidence-based nursing practice taking into consideration current statutes, rules and regulations when developing the plan of care. Establishes, in the collaboration with the family and patient, realistic and measurable patient expected outcomes based on nursing diagnoses, patients present and potential capabilities, goals, available resources and plan for continuity of care. Identifies outcomes that are age appropriate, culturally appropriate, realistic and attainable. Coordinates, collaborates, and delegates appropriately to ensure care is provided in a safe, effective fashion. Fulfills all organizational requirements. Supplemental roles: Charge Nurse (only when acting in this role). ◦ Demonstrates ability to coordinate, delegate, and direct unit operation, collaborates effectively with unit staff, leadership and other disciplines. Preceptor (only when acting in this role). ◦ Demonstrates ability to identify the orientee's learning needs, plans appropriate learning experiences and demonstrates ability to validate clinical competence of orientee. Other duties as assigned. Required Qualifications Associate's or Vocational degree Preferred Qualifications Bachelor's degree Professional RN experience Medical/Surgical experience Licenses/Certifications Licensed Registered Nurse – MN Board of Nursing required if working in state of MN upon hire / WI Department of Safety & Professional Services required if working in the state of WI upon hire Must meet at least ONE of the requirements below: ◦ Current BLS certification from the American Heart Association ◦ Current BLS certification from the American Red Cross ◦ Allina in-house BLS training (within 30 days of hire) Must meet at least ONE of the requirements below (Location specific, some sites may require): ◦ Current ACLS certification from the American Heart Association ◦ Current ALS certification from the American Red Cross ◦ Allina in-house ACLS training (within 60 days of hire) Certified Medical Surgical RN (CMSRN) preferred Additional certifications may be needed at certain sites: ◦ Pediatric Advance Life Support (PALS) within 180 days of hire Physical Demands Medium Work*: Lifting weight up to 32 lbs. occasionally (*Allina Safe Patient Moving Policy), up to 25 lbs. frequently Pay Range Pay Range: $44.64 to $74.33 per hour The pay described reflects the base hourly pay range. Your starting rate would depend on a variety of factors including, but not limited to, your experience, education, and the union agreement (if applicable). Shift, weekend and/or other differentials may be available to increase your pay rate for certain shifts or work. Allina Health is committed to adhering with all applicable local, state and federal minimum wage requirements. Benefit Summary Allina Health believes the best way to provide safe and compassionate care for our patients is by nurturing the passion of those who care for them. That’s why we devote extraordinary resources to help you grow and thrive — not only as a professional but also as a whole person. When you join our team, you have access to a wealth of valuable employee benefits that support the total well-being — mind, body, spirit and community — of you and your family members. Allina Health is all in on your well-being. Because well-being means something different to everyone, our award-winning program provides you with the resources you need to help you navigate your personal journey. This includes well-being dollars, dedicated well-being navigators, and many programs, activities, articles, videos, personal coaching and tools to support you on your journey. We are focused on creating an inclusive workplace so everyone can see themselves as part of our care team. Our care teams are as diverse as the communities we serve and proud to be contributing to the mission of a leading health care organization. Our pioneering approach to well-being helps every member of our care team feel a deep sense of connection and joy in their work. Benefits include: Medical/Dental PTO/Time Away Retirement Savings Plans Life Insurance Short-term/Long-term Disability Voluntary Benefits (vision, legal, critical illness) Tuition Reimbursement or Continuing Medical Education as applicable Student Loan Support Benefits to navigate the Federal Public Service Loan Forgiveness Program Allina Health is a 501(c)(3) eligible employer *Benefit eligibility/offerings are determined by FTE and if you are represented by a union.