Population Health RN; Part-Time

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us. Residency in or relocation to Louisiana is preferred for all positions. This is a part-time position.

Responsible for organizing, coordinating, and providing care coordination and case management services to members who are most at risk for health deterioration, sentinel events, and/or poor outcomes. Manage acute and chronically ill members to improve health and financial outcomes through analysis of needs, design, and delivery of interventions. Utilize a collaborative process to assess, plan, implement, monitor, and evaluate options and services required to meet the member’s healthcare needs.

Through communication, the nurse will identify available resources to promote quality, cost effective outcomes. Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.

• Does not manage people
• Reports to Manager, Population Health
• Maintains contact with Benefits Administration, Medical Director, Underwriting, Group leaders, Delegated Vendors, Legal Department, physicians/staff, hospital administrators/staff, providers, caregivers, subscribers, community resources

• Diploma in nursing or Associate’s in nursing or Bachelor’s in nursing required
• 3 years of recent direct patient care/clinical experience required
• 2 years of experience in managed care preferred
• Experience in the use of behavioral interviewing techniques and theory preferred

• Prioritizes, works independently and anticipates needs to make decisions
• Plans, implements and evaluates appropriate healthcare services in conjunction with a physician treatment plan and evaluates the effectiveness of alternate care services
• Researches and analyzes contracts/cases to make quality and cost effective decisions
• Knowledge of standardized code sets and medical terminology
• Excellent interpersonal, organizational, analytical and telephonic skills
• Strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of insurance/benefits understanding
• Working knowledge of related software and office equipment

• Active and unencumbered RN license to practice in Louisiana required
• Multi-state Compact RN license preferred and required within 6 months of hire
• RN license in noncompact state preferred; may be required to obtain within 6 months of hire
• Certified Case Management Certification preferred and required within 3 years of hire

• Assess members’ status in a culturally competent and confidential manner to identify individual needs and develop a comprehensive case management plan
• Act as an advocate for the member/family, maintain privacy and confidentiality, build relationships with relevant parties, and facilitate access to necessary and appropriate healthcare services across the continuum of care
• Implement and evaluate specific case management activities and interventions to achieve the goals established in the plan
• Coordinate with members/family, providers, third-party payors, employers and community resources to organize, integrate, and modify resources as needed
• Interact with patients and/or providers to determine care needs, compliance, and effectiveness of planned interventions and conduct case conferences as appropriate
• Regularly evaluate the plan’s effectiveness, modify components if necessary, and utilize behavioral interviewing techniques
• Familiar with guidelines for authorizations related to complex case coordination; proficient in care management authorization processes using evidence-based guidelines
• Meet individual quality performance standards and annual targets for program performance, including monthly productivity and annual caseload requirements. Participate in Quality Improvement projects and data collection to determine program effectiveness
• May direct other staff in coordinating care

• Perform other job-related duties as assigned within scope
• Work in a normal and clean office environment with normal noise levels
• Primarily standing or sitting; ability to comprehend, document, calculate, visualize, and analyze required

All employees are equal opportunity and we encourage a diverse workforce.

JOB CATEGORY:
Healthcare/Pharmacy Services