RN Care Manager; Clinic

Responsibilities

Prominence Health is a value‑based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc.

(UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at:

Under the supervision of the Care Management Clinical Program Manager, the RN In‑Clinic Care Manager is responsible for providing care management services for medically and/or socially complex members. The target member population includes individuals with complex medical conditions, multiple hospital readmissions, socio‑economic, or mental health needs panelled to a specific provider group. The goal of the program is to assist these members in achieving optimal health and/or independence in managing their care.

To achieve this goal the RN In‑Clinic Care Manager will demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient‑centered, culturally sensitive care coordination, and management of complex members. The RN In‑Clinic Care Manager will adhere to the CMSA Standards of Practice for Case Management.

The In‑Clinic Care Management (CM) Model establishes a fully integrated, clinic‑embedded approach designed to enhance care coordination, reduce avoidable utilization, and improve outcomes for high‑risk and high‑need members. By pairing the primary care practice with a RN Care Manager (RNCM) supported by Care Coordinators, the model provides proactive, data‑driven, and patient‑centered care management—directly supporting organizational goals across Primary Care and the Health Plan.

The RN In‑Clinic Care Manager is responsible for developing comprehensive care plans for member and family self‑care competence, including motivational assessment, assessing for desired level of involvement, and coaching for adherence to the care plan. The RN In‑Clinic Care Manager assesses the member’s needs, and creates and monitors a specific individualized care plan, including advance care planning. The RN In‑Clinic Care Manager promotes knowledge of the Care Management program to Prominence Health Plan contracted physicians, as well as members.

In addition, s/he is responsible for developing and sustaining partnerships with community resources, support agencies, and supporting the initiatives of Prominence by acting as a liaison between Prominence provider and member to achieve mutual goals.

In addition, the position includes participation in efforts associated with the successful implementation and operation of the SNP CM program and that the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA.

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals,…