RN Care Manager

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.

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Under the supervision of the Care Management Clinical Program Manager, the RN 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, social-economic, or mental health needs. 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 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 Care Manager will adhere to the CMSA Standards of Practice for Case Management.

The RN 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 Care Manager assesses the member’s needs, and creates and monitors a specific individualized care plan, including end of life planning. The RN 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 and support agencies.

Additionally, 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! More information is available on our Benefits Guest Website:

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, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications and Requirements

• Associate or Bachelor’s Degree in Nursing, required.

• Active, unrestricted, current, and valid Compact Registered Nurse license in the States of Practice (Nevada, Texas and/or Florida), required.
• Certified Case Manager (CCM), Case Management Nurse – Board Certified (CMGT-BC), Accredited Case Manager – RN (ACM-RN), or Certified Managed Care Nurse (CMCN),…