Job: Clin RN, Comp Care 8

Jobing Description

Description:
- Clin RN, Comp Care 8 (1100569)

Job Description

Clin RN, Comp Care 8- 1100569

Description (We are proud to be an EEO/AA employer M/F/D/V.)

POSITION SUMMARY:

The RN has the responsibility for supporting the goals and objectives of the care enhancement program by providing high quality telephonic support in an appropriate, efficient and cost effective manner while ensuring high quality care. The RN coordinates with the Primary Care Provider and all other members of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for early identification of those assigned participants who are at risk for increasing acuity, and for intervening with the participants and their Primary Care Provider according to the disease management program intervention guidelines.

An RN is supervised by an LCM (Leader Care Manager). All Healthways clinicians are required to participate in the orientation and to take the pre and post tests to review competency during orientation. Yearly competency test is required for all Healthways clinicians.

RESPONSIBILITIES INCLUDE:

1. Achievement of Clinical Objectives:

A. Reviews status of participant's preventive health exams as defined by the disease-specific Standards of Care guidelines. Initiate appropriate interventions for member.

B. Contacts participant by telephone as needed for information sharing, assessment, intervention and behavioral goal setting.

C. Identifies educational needs of participant and facilitate educational opportunities (i.e. mails patient education materials; refer to health plan if appropriate).

D. Reviews participant's functional status, formal and informal family support system, determining participant's desired outcome of care and needs for participant education.

E. Develops and facilitates implementation of a care plan addressing the total healthcare needs of the participants. Specific focus and resources will be directed to the specific problem resulting in the appropriate stratification level.

F. Identifies participant barriers to accessing health care services. Coordinates with Provider Service Managers and/or other members of the disease management program team when available to remove system barriers.

G. Functions as integral part of the multi-disciplinary team. Facilitates communication exchange with primary managing physician and other providers, health plan, and the disease management program team.

H. Coordinates with other colleagues to ensure continuity of care for assigned participant panel to avoid gaps in care or call campaigns.

I. Accepts warm transfer calls from non-RN colleagues for assessment and/or additional discussion with participant when necessary.

OVERALL QUALIFICATIONS:

This position requires a responsive, committed individual who recognizes the impact of the health care delivery system on the clinical and financial outcomes of the member population and can identify and take action to facilitate system improvements.

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications:

1. The successful candidate must possess a High School diploma and a Diploma in Nursing, an Associate's Degree in nursing or Bachelor's Degree in nursing with a BSN preferred.

2. Minimum of 3 years recent experience in a clinical setting.

3. Ability to be self-directed, highly organized and proactive.

4. Basic knowledge of physiology and chronic disease appropriate for an RN.

5. Excellent listening skills.

6. Language Skills: Ability to communicate with members, other members of the team, physicians, and plan representatives. Effective oral and written communication skills. Ability to read, analyze, and interpret common scientific and technical journals. Ability to effectively present information to audiences with a variety of knowledge/skill levels.

7. Math Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, percent and to draw and interpret bar graphs.

8. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exits. Ability to interpret and organize data in an effective and useful manner; ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

9. Computer Skills: To perform this job successfully, an individual should have basic computer skills and be familiar with a Windows operating system.

10. Counseling/Teaching Skills: Able to effectively educate people in a telephonic environment utilizing and promoting adult learning and behavior change as needed.

Licenses/Certifications

Current RN license appropriate for the state in which the Business Unit is located and able to obtain licensure in other states, as required by state law or contract.

Physical Demands:

The physical demands described here are representative of those that must be met by a colleague to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the colleague is required to sit for long periods at a time; type using a computer keyboard; visually read information off of a computer monitor; talk hear and orally communicate information over the telephone. Specific vision abilities required by the job include close vision and color vision and the ability to adjust focus.

Work Environment:

Work environment characteristics described here are representative of those that must be met by a colleague to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this position, the colleague could be exposed to outdoor weather conditions prevalent at the time. The noise level may vary from light to moderate depending on the location.

SUPERVISORY REPSONSIBILITES:

This position has no supervisory responsibilities.

CRITERIA FOR PERFORMANCE EVALUATION:

Performance evaluation will be based on the RN's abilities in meeting the criteria outlined herein; contributing to meeting the goals and accomplishments of the disease management system and of Healthways, Inc.

To ensure quality of care, monthly chart audits and CDP (Colleague Development Process) are completed by their LCM (Leader Care Manager).

POSITION REPORTS TO:

Leader Care Manager

JOB DESCRIPTION STATUS:

The duties and responsibilities listed in this job description are illustrative ones anticipated for this position. Other duties and responsibilities may be assigned, as required. Healthways, Inc. reserves the right to amend or change this job description to meet the needs of its program. This job description and any attachments do not constitute or represent a contract.

Qualifications

About Healthways:

For three decades, Healthways has been dedicated to improving the human condition. Each year, we learn more and do more for the millions of individuals who count on us to make a difference in their health and well-being. Healthways is a global provider of solutions that help employers, health plans and government agencies enhance business performance and reduce healthcare costs. Our mission is to create a healthier world, one person at a time.

Here at Healthways as we continue to make the world a healthier place, we have also created an environment where people choose to do their best work. Our unique culture thrives on mission-driven individuals who exude a high sense of energy and passion in everything that they do. Collaboration and teamwork are an essential part of everyday life for Colleagues who trust and depend on one another to achieve the highest degree of collective success. We are an organization that strives to recruit the best and the brightest individuals who take pride in the statement "I work for Healthways."

Job
: Clinical / Nursing

Schedule
: Full-time

Shift
: Evening Job

Primary Location
: MO-St. Louis

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